A TRICARE Guide: Understanding Behavioral Healthnavybmr.com/study material/UNDERSTANDING BEHAVIORAL...A TRICARE Guide Understanding Behavioral Health Common Concerns, Helpful Resources,

A TRICARE Guide Understanding Behavioral HealthCommon Concerns, Helpful Resources, and How Your Benefits Work for You

November 2009

An Important Note about TRICARE Program Information

At the time of printing, this information is current. It is important to remember that TRICARE policies and benefits are governed by public law. Changes to TRICARE programs are continually made as public law is amended. Military treatment facility guidelines and policies may be different than those outlined in this publication. For the most recent information, contact your TRICARE regional contractor, TRICARE Service Center, or local military treatment facility.

For information about Patient Rights and Responsibilities, visit www.tricare.mil/patientrights.

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Table of ContentsTRICARE and Your Behavioral Health ...................................3

IfYouNeedHelpRightNow.......................................................4 Don’tWaitforanEmergency.......................................................5 Using thisGuide...........................................................................5

Understanding Behavioral Health ........................................6

StressandtheTollItTakes..........................................................6 RecognizingSignsandSymptoms..............................................11 CommonBehavioralHealthConditions.....................................12

Covered Services, Limitations, and Exclusions ..................16

OutpatientServices......................................................................16 InpatientServices........................................................................20 Exclusions...................................................................................23 Costs............................................................................................24

Who to See for Care ............................................................26

BehavioralHealthCareProviderTypes.....................................26 SelectingaProvider....................................................................27 BeforeYouTravel.......................................................................28

Getting Care .........................................................................30

ActiveDutyServiceMember.....................................................32 ActiveDutyFamilyMember......................................................38 NationalGuardorReserveMemberorFamilyMember.............46 RetiredServiceMemberorFamilyMember..............................52 Medicare-EligibleTRICAREBeneficiary..................................58

Your Right to Privacy ...........................................................63

MedicalRecordsandPrivacy.....................................................63 HIPAAandPrivacy....................................................................63 ReleaseofRecordsandPersonalHealthInformation.................64 Alcohol,DrugAbuse,andMentalHealthAdministrationReorganizationActof1992...........................64

www.tricare.mil

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For Information and Assistance ......................................... 65

TRICAREinYourRegion..........................................................65 OtherBehavioralHealthResources.............................................70 RecommendedReadingList.......................................................71 OnlineBehavioralHealthResources..........................................72

Acronyms ............................................................................. 74

Glossary ............................................................................... 76

List of Tables ........................................................................ 81

Index .................................................................................... 82

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TRICARE And youR bEhAvIoRAl hEAlTh

TRICARE and Your Behavioral HealthBehavioralhealthisatermusedinterchangeablywithmentalhealth.Unfortunately,manypeoplearestillreluctanttoseekbehavioralhealthcarebecausethey’reafraida“stigma”surroundsbehavioralhealthproblems.

Noonequestionstheneedformedicalcareforasprainedarmoraheartproblem.However,whenpeopleexperienceemotionalproblemstheymayfeelembarrassedandafraidtoseekhelpwhenthetroublingsignsfirstsurface.Sometimes,peopletrytoconvincethemselvestheproblemswillgoawayontheirown—theyjusthaveto“toughitout”untilthathappens.Someemotionaldifficultieswill goawaywithtime.But,justlikeaheartconditionthat’signored,somebehavioralhealthproblemsworsenifleftuntreated.Don’tletthishappentoyou.

Ourmilitaryleadership,fromthesecretaryofdefensedownthechainofcommand,recognizestheneedforaddressingbehavioralhealthcareissuesformenandwomeninuniform,theirfamilies,andretirees.TworecentDepartmentofDefense(DoD)initiativesincludenewpost-traumaticstressdisorder(PTSD)treatmentprogramsforreturningservicemembersandexpandedcounselingforservicemembers,retirees,andtheirfamilies.

AdditionalDoDeffortsareunderwaytobattlethestigmaanddiscriminationsurroundingpsychologicaldisordersandencourageservicemembersandfamiliestoseekbehavioralhealthcare.Forinstance,theMentalHealthSelf-AssessmentProgram(www.militarymentalhealth.org/welcome.asp),anonlineresourcefundedbyDoDForceHealthProtectionandReadiness,offersanonymousself-assessmenttoolstohelpyouandyourfamilymembersidentifypossiblebehavioralhealthsymptomsandprovidesguidanceonhowtogethelp.

Thisprogramalsopromotesthenecessityofobtainingbehavioralhealthcareinitseducationalvideo,A Different Kind of Courage: Safeguarding and Enhancing Your Psychological Health.

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Toviewthevideoandtakeadvantageoftheself-assessmenttools,visit www.mentalhealthscreening.org/military.ForadditionalDoDresourcesdesignedtoassistyouingettingthecareandsupportyoudeserve,visitwww.warriorcare.mil.

Reversingyearsofstigma,adoptingnewwaysofrecognizingbehavioralhealthcareneeds,andmakingpositivechangeswilltaketime.However,thechangehasstartedandprogressisbeingmade.Itisinthebestinterestofsoldiers,theirfamilies,andthemilitarytoseekhelpratherthanignorebehavioralhealthproblemsthatcanputallatrisk.

If You Need Help Right Now

Toooften,apersonfailstoreachoutforhelpuntilheorsheisinthemidstofacrisis.Ifyouhavepickedupthisguidebecauseyoufeelasthoughyouoraclosefamilymemberneedshelprightnow,don’t wait until the situation worsens.Here’swhatyoushoulddo.

If it is an emergency, call 911 or go directly to the closest emergency care or psychiatric health care facility.Anemergencymeansthatthephysicalwell-beingofanindividualorthosearoundhimorherisatrisk.

In the U.S., you can call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or TTY: 1-800-799-4889.Thishotlineisa24-hour,toll-freesuicidepreventionserviceavailabletoanyoneinsuicidalcrisis.Youwillberoutedtotheclosestpossiblecrisiscenterinyourarea.Yourcallisfreeandconfidential.VeteranslivingintheU.S.maycall1-800-273-TALK (1-800-273-8255) and press “1”toreachtheDepartmentofVeteransAffairs(VA)hotline,whichisstaffedbybehavioralhealthprofessionalswhoworkcloselywithlocalVAbehavioralhealthcareproviders.Note:ThisnumberisnotfreeofchargeifdialedfromoutsidetheU.S.

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TRICARE And youR bEhAvIoRAl hEAlTh

Don’t Wait for an Emergency

Ifyoursituationisnotanemergency,readthisguidetolearnaboutthebehavioralhealthcareinformationandservicesthatareavailabletoyou.Ifyou’restillconcernedorfeelingasthoughyouneedtotalktoaprofessional,TRICAREcoversthoseservices.

Using this Guide

Thisguideisintendedtohelpyouunderstandsomeofthemorecommonbehavioralhealthissues,aswellaswhentoseekcare.TheguideprovidesvaluableinformationaboutyourTRICAREbenefit,guidelinesaboutwhenyoumayneedreferralsandauthorizationforcare,andwhotocontactforhelp.You’llalsofindeasy-to-understandinformationaboutconditions,symptoms,andpossiblewarningsigns.

Manypeoplethinkonlyapsychiatristorpsychologistcanprovidebehavioralhealthcare.Thereareactuallyseveraldifferenttypesofproviders,andthisguidewillhelpyouunderstandhowtofindoneandlearnwhattypesoftreatmentareavailable.

TheGetting Caresectionprovidesabreakdownofcareaccessguidelinesbyyourbeneficiarytypeandprogramoption.Youcanalsoreadaboutlifeeventscommontoeveryoneorchallengesandconcernsspecifictomilitaryfamilies.

Your Right to Privacyisasectiondetailingyourprivacyrightsandhowyourmedicalandbehavioralhealthrecordsareused.

RefertotheFor Information and Assistancesectionofthisguideforimportantcontactinformationandhelpfulresources,includingalistofrecommendedreadingandotherresources.

Keepinmindthatthisguideisonlyaninformationalresource.Itisnotasubstituteforprofessionalcare.Nevertrytodiagnoseyourselforalovedonebasedoncertainsymptomsorbehaviors.Alwaysleavediagnosisandtreatmenttotheexpertswhoarewaitingtohelp.

www.tricare.mil

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Understanding Behavioral Health

Stress and the Toll It Takes

Militarylifeischallengingandoftenunpredictableforservicemembersandtheirfamilies.Frequentdeployments,moves,andextendedseparationsarejustafewexamplesofthestressesservicemembersandtheirfamilymembersface.Addtothatthedailysituationsthatcreatestressforeveryone:jobfrustrations,problemsatschool,financialandmedicalhealthworries.It’snotuncommonfortheseissuestoleadtofeelingsofanxiety,anger,orsadness.

Whenstressisminimizedorwell-managed,thesefeelingswillcomeandgo,butultimatelyshouldpass.Whensomeoneisexposedtolong-termstress,seriousphysical,emotional,andbehavioralhealthissuescanresult.

Stresscanweakenyourimmunesystem,makingithardertofightdiseases.Becauseitcanmakeyoumoodyandtense,yourrelationshipsmaysuffer,andyourperformanceatworkorschoolmaydecline.Ifstresspersistswithouttreatment,itcanleadtodepressionandmoreseriousbehavioralhealthconditions.

Stress and the Deployment Life Cycle

Deployment,perhapsthemostchallengingpartofmilitarylife,canbeanemotionalrollercoasterridepackedwithunpredictablechallengesforservicemembersandtheirfamilies.Theseemotionalexperiencesarenormalreactionstochange,andevenjustknowingwhattoexpectcanhelplessenthenegativeimpactofthosechallenges.

Thefollowinginformationoffersinsightintowhatyoumaybefeelingandtipsformanagingthetransitionsthatoccurduringthedeploymentlifecycle.Takenoteifanyoftheseemotionaldifficultieslastforanextendedperiodoftime.Ifso,itmaybetimetoseekprofessionalassistance.

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Pre-Deployment: The Stress of Saying Goodbye

What to Expect:Oftenthemostdifficultstageofthedeploymentcycle,thepre-deploymentphasefindsmilitaryfamiliesstrugglingtomakethingswork.Beforedeployment,familiesfindthemselvesrunningextraerrands,settinguptheirfinancesforthenextyear,andpreparingchildrenforthechange.Additionally,servicemembersspendagoodbitoftimeawayfromhomepreparingandtrainingfortheupcomingdeployment.Asaresult,militaryfamiliesexperiencetension.Couplesmayfeelasiftheyarearguingallofthetime.Childrenmaythrowtantrums,orontheoppositeextreme,actasthoughtheydon’tcareaboutthedeployment.

What to Do:Thesedifficultiesarenormalpriortodeployment.Normallifeexperienceshowsthatpeopletendtoarguejustpriortoananticipatedseparation.However,it’simportanttoresolveissuesbeforedeploymenttomaintainpositiverelationshipsduringtheseparation.Apositiveenvironmentwillmakethetransitionmuchsmootherforeveryoneinvolved.

Deployment: Maintaining Normal Activities

What to Expect:Thedeploymentstagecreatesmixedemotionsformilitaryfamilies.Servicemembersmayfeelsad,numbtothedeployment,alone,orabandoned.Atthesametime,thespousemayfeeldisorientedoroverwhelmedwithadditionalresponsibilities.Childrenalsofeeltheeffectsofdeploymentandmayhavedifficultysleeping.Theymayfeelanxious,fearful,lonely,orcomplainofphysicalsymptoms,suchasfrequentstomachaches.

What to Do:Tosuccessfullynavigatethedeploymentphase,it’simportantthatyouandyourfamilymembersmaintainanormalroutine.Servicememberscantakeupahobbyduringdeployment,whilespousesandchildrenshoulddowhattheycantosticktotheirnormalactivities.“HelpingKidsPasstheTimeWhileYou’reApart”onthefollowingpageofferssomeideasforhelpingchildrenthroughthedeploymentphase.

undERsTAndIng bEhAvIoRAl hEAlTh

www.tricare.mil

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Helping Kids Pass the Time While You’re Apart

Listedhereareafewideasforhelpingchildrenpositivelyfocustheirenergyandemotionsduringdeployment:

Havefamilyfunnights.•

Makeavideoofthefamilyduringthedeployment.•

Hostboardgametournaments.•

Createascrapbooktogether.•

Encouragethemtotakeupanewactivity(• e.g., sports or dancing).

Findanorganizationinyourcommunityandsuggestthey•volunteerafewtimesaweek.

Keepatimelineofimportanteventstosharepost-deployment.•

Sustainment and Post-Deployment: Returning to Routine

What to Expect:Astimepasses,militaryfamiliesbecomeaccustomedtotheirnewroutinesandlearntocopewiththeseparation.Afterafewbumpsalongtheway—missedphonecalls,familyemergencies,andlong-distancechallenges—eventually,thetimecomesfortheservicemembertocomehome.

Returninghomecanpresentawholenewsetofchallengesforamilitaryfamily.Establishedroutinesaredisrupted.Theservicemembermayhavedifficultyreconnectingwiththefamily,andthespousemaynotwanttogiveuptheresponsibilitiesheorshehastakenon.

What to Do:Duringthisstage,itisimportantforfamiliestotakeitslowlyandbecomereacquaintedwitheachother.Forspouses,communicationisextremelyimportantduringthisperiod.It’svitaltoclearlycommunicatewhatrolechangeshaveoccurredduringdeploymentanddiscusswhatchangesshouldbemadenowthattheservicememberishome.

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Thepost-deploymentphasemayposespecialchallengesforchildren.Youngerchildrenmaynotremembertheservicememberastheirparent.Olderchildrenmayrequirealotofattention,whileteenagersmayappeartonotevencarethattheparenthasreturnedhome.Letchildrensettheirownpace.Intime,thecomfortofhavingmomordadbackhomewillreturn.

The Basics of Self-Care

Duringdifficulttimes,suchasdeploymentsorotherdisruptiveperiods,it’simportantforeveryonetomaintainawell-balancedroutine.Listedhereareafewtipsonjusthowtodothat:

Spendtimewithyourfamily.•

Keepyourspiritsup.Takeawalk,rideabike,orfrequent•thegym.

Dosomethingforyou.•

Getplentyofrest.•

Establishanetworkofsupport.Thiscanbefamily,friends,ora•supportgrouponbase.

Makeplanstopassthetimewhileyou’reawayfromyourloved•ones.Familymemberscantakeatripandservicememberscantakeupahobby.

Trytoavoidthesecommonpitfalls:

Rumorsandlossoftrust•

Over-interpretingarguments•

Refusingtoacceptchangesinyourrelationships•

Duringdeployments,puttingtoomuchimportanceonthedateof•returnbecausedatescanchange

Overspending•

www.tricare.mil

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Self-Help Tips for Managing Your Stress

Therearemanywaystomanagestress.Trythesetechniques:

Getmoresleepandrest.•

Avoidalcoholandtobacco.•

Discontinueordecreasecaffeineintake.•

Eatabalanceddiet.•

Taketimetoexerciseregularly,aloneorwithyourfamily.•

Tryanewhobby.•

Buildastrongnetworkoffriendsandfamilywithwhomyou•cantalk.

Keepajournal.•

Spendtimewithlovedones.•

Findtimetobealoneandrelaxortrymeditation.•

Manageyourtimewell—avoidoverschedulingyourdayand•makelists.

Periodicallycleanandorganizeyourpersonalspace.•

Makeanefforttofocusonthepositiveaspectsofasituation.•

Trytofindhumorinsituationsand/orwatchafunnytelevision•showregularly.

Get Self-Help Online at www.afterdeployment.org

Duringpost-deploymenttransitions,returningservicemembersandtheirfamiliescantakeadvantageofinteractivebehavioralhealthinformationatwww.afterdeployment.org.Theuser-friendlysiteoffersconfidentialeducationaboutahostofimportanttopics,including:stress,itstriggers,andhowtomanageit;workconflicts;reconnectingwithfamilyandfriends;moods;anger;sleep;andspecialdeploymentchallengesfacedbychildren.Privacyisnotaconcernbecauseyoudon’tneedtoregistertoaccesstheWebsite.Justcreateausernameandpasswordtoexplorethevaluabletoolsandinformationavailableatwww.afterdeployment.org.

Practicingself-helpmethodsshouldlessenoratleasthelpyoucopewithnormalstress.Iftheydon’tseemtowork,itmightbeagoodideatoseekprofessionalassistancefromahealthcareprovider.

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Recognizing Signs and Symptoms

Beingawareofhowyoufeeliskeytorecognizingsignsofstress.Itiscommontofeelanxious,sad,orevenangry,especiallybefore,during,andafterdeployment,apermanentchangeofstation,retirement,orotherstressfulevents.Thequestionis,howlongdothosefeelingslast?Iftheyoranyofthefollowingcommonsignsandsymptomspersistformorethanafewweeks,youshouldconsiderseekingprofessionalassistance:

Lackofenergy•

Difficultysleepingorsleepingtoomuch•

Rapidweightlossorgain•

Reducedperformanceathomeoratwork•

Irritability•

Lossofappetite•

Anxiety•

Beawarewhenyourfeelingsbegintonegativelyaffectyourabilitytoperformdailyactivities.Takenotewhen:

At work: • Youcan’tconcentrateandhavedifficultycompletingtasks.

At home: • Youhavedifficultywithorlackenergyforeverydayactivities,suchascaringforyourhome,payingbills,orkeepingupyourpersonalappearance.

In relationships: • Youcan’tholdconversationswithfriendsoryoufeeldisconnectedfromyourfamilymembersandfriends.

Your children: • Yourchildisfearfulofnewpeopleorsituations,hasdifficultyatschool,isactingoutathome,haslostinterestinsportsorhobbies,orexpresseslowself-esteemandself-criticism.


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Common Behavioral Health Conditions

Whenemotionalproblemssurface,it’snotuncommontosimplydenythatsomethingiswrong.However,ignoringsuchsignsandsymptomscanincreaseyourchanceofdevelopinganyofthefollowingmoreseriousconditions.Likeanymedicalailment,behavioralhealthconditionsarebesttreatedwhendetectedearly.Thefollowingareshortdescriptionsthatdefinecommonbehavioralhealthconditions.

Anxiety Disorder:Anxietyisacommonemotion,oftenfeltwhenfacingaproblemorwhenmakinganimportantdecision.Youshouldbealertifanxietybeginstoaffectyourabilitytoleadanormallife.Feelingsofpanic,fear,anduneasinesslastinglongerthanafewweekscanbesignsofananxietydisorder—amuchmoreseriouscondition.

Attention Deficit Hyperactivity Disorder (ADHD):ADHDaffectschildren,andsomeofitssymptomsincludedifficultypayingattention,focusingontasks,orsittingforevenashortperiodoftime.Ifleftuntreated,ADHDcancauseproblemsathome,school,work,andinrelationships.

Depression:Clinicaldepressionismorethanjustfeelingsadafteradifficultperiod.Depressionmaybediagnosedwhenfeelingsofsadness,loss,andhopelessnesslastlongerthanatypicalperiodofgrief.Undiagnoseddepressioncanleadtomoreseriousbehavioralhealthissues.Somesignsandsymptomsofdepressioninclude:

Sadness•

Lossofenjoymentinthingsthatwereoncepleasurable•

Lossofenergy•

Feelingsofhopelessnessorworthlessness•

Difficultyconcentrating•

Difficultymakingdecisions•

Insomniaorexcessivesleep•

Upsetstomachanddigestiveproblems•

Sexualproblems(• e.g., decreased interest in sex)

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Achesandpains(• e.g., recurrent headaches)

Changesinappetitecausingweightlossorgain•

Thoughtsofdeath,suicide,orself-mutilation•

Self-mutilationorattemptingsuicide•

Eating Disorders: Feelingsofstress,anxiety,anddepressioncanleadtoeatingdisorders.Individualswithaneatingdisordercanuseeating,purging,orseverelyrestrictingtheirdietasawaytocopewithamoreseriousproblem.Eatingdisordersfallintothreecategories:

Anorexianervosa:Severelylimitingtheamountoffood•that’seaten

Bulimianervosa:Eatinglargeamountsoffoodinashorttime•andtheneliminatingit

Bingeeatingdisorder:Uncontrollableeatingresultingin•weightgain

Mild Traumatic Brain Injury (TBI):MildTBIisaninvisibleyetphysicalinjurythatmaybecausedbybeingclosetoanexplosionorablowtothehead.TosufferfrommildTBI,youdonotneedtohavebeenvisiblyharmedorevenknockedunconscious.Ifyouwerenearanexplosionorsufferedablowtotheheadandexperiencesymptomssuchaspoorconcentration,anxiety,fatigue,andlackofenergy—considertalkingtoyourdoctor.

Post-Traumatic Stress Disorder (PTSD):Servicemembersareoftensubjecttotraumaticeventswhiledeployed.Memoriesofcombatexperiencescanremainburieddeepinthesubconsciousandunexpectedlyemergeupontransitionbackintocivilianlife.Youmayexperienceflashbacks,nightmares,anxiety,andirritability.Youmayalsofeelexhaustedbecauseyou’reusingallofyourmentalenergytodealwiththethreatofthosere-emergingexperiences.

It’snormaltoexperienceadegreeofpost-traumaticstresswhenreturningfromdeployment.Thetimetoseektreatmentiswhentheseexperiencespersist,occurfrequently,andaffectyourabilitytoleadanormallife.


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Substance Use Disorder:Undiagnosedstress,anxiety,anddepressioncanleadtoabuseofalcoholordrugs—asubstanceusedisorder.Individualswhousealcoholordrugsasameansofcopingmaybeathighriskforsuicidalbehavior.Forthemostsuccessfultreatmentofsubstanceusedisorder,earlydetectionisthekey.Afewbehaviorstowatchforare:

Thesubstancebeingtakeninincreasinglylargeramounts•(including excessive amounts of alcohol or abuse of prescription medications)

Unsuccessfuleffortsatcuttingdownorcontrollingtheamount•ofthesubstanceused

Agreatdealoftimespentonactivitiesnecessarytoobtainthe•alcoholordrugs

Substanceusecontinuesdespitenegativeconsequences•

Aggressivenessandincreasedirritability•

Hopelessness,depression,orsuicidalbehavior•

Avoidingfriendsorfamilyinordertodrinkortakedrugs•

Takingunnecessaryrisks•

Suspensionfromschoolorwork•

Suicidal Thoughts:Stress,anxiety,anddepressionincreasethelikelihoodofsuicidalthoughtsand/orattempts.Untreated,theseconditionscancauseanindividualtofeelisolatedandbelievetheyhavenowheretoturn.Ifyoubelieveyouknowsomeonewhoisathighriskforsuicide,payattentiontotheseriskfactors:

Previoussuicideattempt(s)•

Historyofbehavioralhealthdisorders,particularlydepression•

Historyofalcoholandsubstanceabuse•

Familyhistoryofsuicide•

Troubleaccessingbehavioralhealthcare•

Recentstressorloss•

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Alongwiththesecommonriskfactors,therearenumeroussuicidewarningsigns:

Withdrawalfromfriendsorfamily•

Deepsadness•

Droppinghintsofself-loathing•

Puttingpersonalaffairsinorder•

Changeineatingorsleepinghabits•

Rebelliousbehavior•

Drugandalcoholabuse•

Unusualneglectofpersonalappearance•

Significantpersonalitychange•

Lossofinterestinpleasurableactivities•

Increasedinterestindeath•


www.tricare.mil

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Covered Services, Limitations, and ExclusionsAvarietyofbehavioralhealthresourcesareavailabletohelpyou.ThissectionexplainsTRICARE’sbehavioralhealthcarebenefits—what’scoveredandwhatisn’tcovered,aswellasgeneralcostdetails.Thesebenefitsapplyregardlessofyourprogramoptionorlocation,unlessotherwisenoted.Note:Ifyouareanactivedutyservicemember(ADSM),militarytreatmentfacility(MTF)guidelinesmaydifferfromthoseoutlinedinthissection.RefertoyourMTForMilitaryMedicalSupportOfficeservicepointofcontactfordetails.Formoredetailedinformationorforhelpwithaquestionthatthisguidehasn’tanswered,contactyourlocalTRICAREregionalcontractor,TRICAREServiceCenter(TSC),TRICAREGlobalRemoteOverseas(TGRO)AlarmCenter,orTRICAREAreaOffice(TAO).ContactinformationislistedintheFor Information and Assistancesection.

Outpatient Services

Referralsandauthorizationsmayapplyforcertainoutpatientservices(does not apply to ADSMs receiving care at an MTF).Careaccessandrulesvarybybeneficiarytype,location,andTRICAREprogramoption.RefertotheGetting Caresectionforthosedetails.

Psychotherapy

Psychotherapyisaninterpersonal,discussion-basedtypeofbehavioralhealthcare.Whenmedicallyorpsychologicallynecessarytotreatabehavioralhealthdisorder,outpatientandinpatientpsychotherapyiscovered.Outpatientpsychotherapyiscovereduptotwosessionsperweekinanycombinationofindividual,family,collateral,orgroupsessions.Inpatientpsychotherapyiscovereduptofivesessionsperweekinanycombinationofsessions.Thedurationandfrequencyofadditionalcareisdependentuponmedicalnecessity.Thefollowingtypesoftherapysessionsarecovered:

Individual Psychotherapy: • Therapymaybeusedforadultsandchildrentoeaseemotionalissues,reverseorchangetroublingbehavior,andencouragepersonalitygrowthanddevelopment.

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CovEREd sERvICEs, lImITATIons, And ExClusIons

Sessionsarecoveredupto60minutes;crisissessionsmayextendupto120minutes.Note:Individualpsychotherapyisnotacoveredbenefitforapatientwithadiagnosisofsubstanceabuseunlessthepersonalsohasamentaldisorderdiagnosis.

Play Therapy: • Aformofcoveredindividualpsychotherapyusedtodiagnoseandtreatchildren.

Family or Conjoint Psychotherapy: • Therapyisdesignedtotreattheentirefamily.Regularsessionsarecoveredforupto90minutes;crisissessionsmayextendupto180minutes.

Group Psychotherapy: • Sessionsarecoveredforupto90minutes.

Collateral Visits: • Acollateralvisitisnotatherapysession.Thesevisitsareusedtogatherinformationandtoimplementtreatmentgoals.Collateralvisitsarecountedasindividualpsychotherapysessionsandcanlastupto60minutes.Beneficiarieshavetheoptionofcombiningacollateralvisitwithanotherindividualorgrouppsychotherapyvisit.

Psychoanalysis

Psychoanalysisdiffersfrompsychotherapyandrequirespriorauthorization.Afterpriorauthorizationisobtained,itiscoveredwhenadministeredbyagraduateorcandidateofapsychoanalytictraininginstitution.

Psychological Testing

Psychologicaltestingandassessmentiscoveredonlywhenprovidedinconjunctionwithpsychotherapy.Testingislimitedtosixhoursperfiscalyear(October 1–September 30).Anytestingmorethansixhoursrequiresareviewformedicalnecessity.

Medication Management

Ifyouaretakingprescriptionmedicationsforabehavioralhealthcarecondition,youmustbeunderthecareofaproviderwhoisauthorizedtoprescribethosedrugs.Yourproviderwillmanagethedosageanddurationofyourprescription.

www.tricare.mil

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TRICARE Assistance Program

TheTRICAREAssistanceProgram(TRIAP)isaWeb-basedprogramthatusesaudio-visualandinstantmessagingfeaturestoprovideonlineaccesstocounselingforshort-term,non-medicalissues.ThefollowingstatesideTRICARE-eligiblebeneficiariesmayuseTRIAP:

ADSMs•

Activedutyfamilymembers(ADFMs)(• Spouses of any age are eligible, but dependent family members must be age 18 and older.)

TRICAREReserveSelect(TRS)enrollees(• age 18 and older)

TransitionAssistanceManagementProgram(TAMP)enrollees•(age 18 and older)

Ifyouareeligible,youcanuseyourhomecomputertocontactlicensedbehavioralhealthcareprofessionals24hoursaday,sevendaysaweek.Youcanhaveaprivate,solution-focuseddiscussionwithaTRIAPcounseloraboutmanyday-to-dayissues,including:

Stressmanagement(• work, family, personal)

Familydifficultiesandpressure•

Deploymentsandotherfamilyseparations•

Relationshipsandmarriage•

Parent-childcommunication•

Self-esteem•

TRIAPservicesdonotrequirereferralsorauthorizations,butyouwillneedaphoneandacomputer.YoumayaccessTRIAPanunlimitednumberoftimes,andservicesareconfidentialandnon-reportable(not documented on your military record).TRIAPservicesdonotincludemedicationmanagement,financialcounseling,oremergencycare.Ifnecessary,aTRIAPcounselorcanreferyouforhigher-levelbehavioralhealthcare,whichmayincludeface-to-facecounseling.

Visitwww.tricare.mil/TRIAPformoreinformationaboutTRIAPbenefitsandrequirements.TorequestTRIAPservices,contactyourregionalcontractor.

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Telemental Health Program

TheTelementalHealthprogramusessecureaudio-visualconferencingtoconnectqualifyingbeneficiarieswithoffsiteTRICARE-authorizedproviders.ThefollowingstatesideTRICARE-eligiblebeneficiariesmayusetheTelementalHealthprogram:

TRICAREPrime-enrolledADSMsandADFMs•

TRICAREStandardandTRICAREExtrabeneficiaries•

TRSenrollees•

TRICAREPrime-enrolledretireesandfamilymembers•

TheTelementalHealthprogramprovidesmedicallynecessarybehavioralhealthservices,including:

Clinicalconsultation•

Individualpsychotherapy•

Psychiatricdiagnosticinterviewexamination•

Medicationmanagement•

TelementalHealthinteractionmayinvolvesecuretwo-wayaudio-visualvisitsbetweenpatientsandmedicalprofessionals.BeneficiariescanaccesstheseservicesbyvisitingTRICARE-authorizedTelementalHealth-participatingfacilitiestocontact,viaatelecommunicationssystem,TRICAREnetworkprovidersatremotelocations.Fromtheiroffsitelocation,TelementalHealthproviderscanevaluate,treat,andreferyouforfurthercare.

TRICAREbehavioralhealthcarereferralandauthorizationrequirementsandlimitationsapply.ADSMsmusthaveareferralfromtheirMTFprimarycaremanager,SPOC,orMTFbehavioralhealthcareclinicpriortoobtainingcivilianbehavioralhealthcare.IfyouareaTRICAREPrime-enrolledADSMorADFM,therearenoassociatedcost-sharesorchargesforTelementalHealthservices.TRICAREStandardandExtra,TRICAREPrimeretireesandtheirfamilies,andTRSenrolleesmustpayapplicablecost-shares,deductibles,andcopayments.TelementalHealthavailabilityislimitedtoareaswhereparticipatingsitesarelocated.

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FormoreinformationaboutTelementalHealth,visittheMental Health and BehaviorWebpageatwww.tricare.milorcontactyourregionalcontractor.ContactinformationisavailableintheFor Information and Assistancesectionofthishandbook.

Inpatient Services

Availability,careaccess,referral,andauthorizationrequirementsforinpatientservicesmayvarybybeneficiarytype,location,andTRICAREprogramoption.RefertotheGetting Caresectionforthosedetails.Note:Priorauthorizationisrequiredforall nonemergencyinpatientbehavioralhealthcareservices.Inemergencysituations,authorizationisrequiredforcontinuedstay.Note:ADSMswhoreceivecareatanMTFdonotrequirepriorauthorization.

Acute Inpatient Psychiatric Care

Patientsmaybereferredtoacuteinpatientpsychiatriccareiftheirdoctorbelievestheyhaveabehavioralhealthdisorderthatthreatenstheirphysicalwell-beingtotheextentthat24-hourmedicalandpsychiatriccareisneeded.

Benefit Limits:

Patients19andolderarelimitedto30daysperfiscalyear(FY)*•orinanysingleadmission.

Patients18andyoungerarelimitedto45daysperFY*orinany•singleadmission.

* The FY is October 1–September 30. Day limits may be waived if determined to be medically or psychologically necessary.

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Psychiatric Partial Hospitalization Program

Apsychiatricpartialhospitalizationprogram(PHP)isrecommendedwhenyourphysicianbelievesitisnecessarytostabilizeacriticalbehavioralhealthdisorderortotransitionfromaninpatientprogramtoanoutpatientprogram.

Treatment Frequency:APHPisatreatmentsettingprovidingmedicaltherapeuticservicesatleastthreehoursperday,fivedaysperweek.Treatmentmayincludeday,evening,night,andweekendprograms.

Benefit Limit:TRICAREprovidesupto60daysofcoverageperFY(full- or half-day program)inaTRICARE-authorizedprogramforbehavioralhealthdisorders.PHPtreatmentforadiagnosisofasubstanceusedisorderislimitedtotherehabilitationtreatmentmaximumoutlinedin“SubstanceUseDisorders.”PHPcaredoes notcounttowardthe30-or45-daylimitforacuteinpatientpsychiatriccare.Note:Atthetimeofprinting,alimitednumberofTRICARE-certifiedPHPswereavailableandwereonlyavailableintheU.S.anditsterritories.

Residential Treatment Center Care

Residentialtreatmentcenters(RTCs)provideextendedcareforchildrenandadolescentswhohavepsychologicaldisordersrequiringtreatmentinatherapeuticenvironment.

Benefit Limit:TRICAREcoversupto150daysinaTRICARE-authorizedRTCandmaycovermoreifthecareismedicallyorpsychologicallynecessary.

RTCcareisnotcoveredinemergencies,andadmissionprimarilyforsubstanceabuseisnotauthorized.Caredoes not counttowardthe30-or45-daylimitforacuteinpatientpsychiatriccare.YourTRICAREbenefitprovidesRTCcareuptoage21;however,mostRTCsdonotacceptindividualsolderthanage17.Note:Atthetimeofprinting,RTCswereonlyavailableintheU.S.anditsterritories.

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Substance Use Disorders

Substanceusedisordersincludealcoholordrugabuseordependence.ServicesareonlycoveredbyTRICARE-authorizedinstitutionalproviders—anauthorizedhospitaloranorganizedtreatmentprograminanauthorizedfree-standingorhospital-basedsubstanceusedisorderrehabilitationfacility(SUDRF).Treatmentincludesdetoxification,rehabilitation,andoutpatientindividual,group,andfamilytherapy.

Benefit Limit:TRICAREcoversthreesubstanceusedisorderrehabilitationtreatmentsinalifetimeandoneperbenefitperiod.Abenefitperiodbeginswiththefirstdateofthecoveredtreatmentandends365dayslater.

Detoxification (Emergency Inpatient)

TRICAREcoversemergencyinpatientchemicaldetoxificationtreatmentwhenthepatient’sconditionrequiresthepersonnelandfacilitiesofahospitalorSUDRF.UptosevendaysperepisodeiscoveredinaTRICARE-authorizedfacility.TRICAREmaycovermoredaysifdeterminedtobemedicallyorpsychologicallynecessary.Inpatientdetoxificationcarecountstowardthe30-or45-daylimitforacuteinpatientpsychiatriccare,butnottowardtherehabilitationlevelofcare.

Rehabilitation

Rehabilitationofasubstanceusedisordermayoccurinaninpatientorpartialhospitalizationsetting.TRICAREcovers21daysofrehabilitationperbenefitperiodinaTRICARE-authorizedfacility,whetheraninpatientorpartialhospitalizationoracombinationofboth.Inpatientdaysforrehabilitationcounttowardthe30-or45-daylimitforacuteinpatientpsychiatriccareandpartialhospitalizationdayscounttowardthe60-daylimitforpartialhospitalization.

Outpatient Care

OutpatientcaremustbeprovidedinanindividualorgroupsettingbyanapprovedSUDRF(free-standing or hospital-based).Benefitlimitsareasfollows:

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Individualandgrouptherapy:Upto60visitsperbenefitperiod•(only within the SUDRF)

Familytherapy:Upto15visitsperbenefitperiod•

Limitsmaybewaivedifmorevisitsaredeemedmedicallyorpsychologicallynecessary.

Exclusions

ThefollowingbehavioralhealthcareservicesarenotcoveredunderTRICARE.This list is not intended to be all-inclusive.

Aversiontherapy(• including electric shock and the use of chemicals for alcoholism, except for disulfiram, which is covered for the treatment of alcoholism)

Behavioralhealthcareservicesandsuppliesrelatedsolelyto•obesityand/orweightreduction

Bioenergetictherapy•

Biofeedbackforpsychosomaticconditions•

Carbondioxidetherapy•

Counselingservices,suchasnutritionalcounseling,stress•management,maritaltherapy,orlifestylemodifications

Custodialnursingcare•

Diagnosticadmissions•

Educationalprograms•

Environmentalecologicaltreatments•

Experimentalprocedures•

Eyemovementdesensitizationandreprocessing(EMDR)•

Filialtherapy•

Guidedimagery•

Hemodialysisforschizophrenia•

Intensiveoutpatienttreatmentprogram•

Marathontherapy•

Megavitaminororthomoleculartherapy•


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NarcotherapywithLSD•

Primaltherapy•

Psychosurgery(• Surgery for the relief of movement disorders, electroshock treatments, and surgery to interrupt the transmission of pain along sensory pathways are not considered psychosurgery.)

Rolfing•

Sedativeactionelectrostimulationtherapy•

Servicesandsuppliesthatarenotmedicallyorpsychologically•necessaryforthediagnosisandtreatmentofacoveredcondition

Sexualdysfunctiontherapy•

Servicesandsuppliesrelatedto“stopsmoking”regimens•

Telephonecounseling(• except for geographically distant family therapy related to RTC treatment)

Therapyfordevelopmentaldisorderssuchasdyslexia,•developmentalmathematicsdisorders,developmentallanguagedisorders,anddevelopmentalarticulationdisorders

Traininganalysis•

Transcendentalmeditation•

Ztherapy•

Costs

Yourfinancialresponsibilityforbehavioralhealthcareservicesdependsonyourbeneficiarycategory,whichTRICAREoptionyouuse,andthetypeofprovideryousee.Forspecificcostdetails,visitwww.tricare.mil/costs.

BeneficiariesenrolledinaTRICAREPrimeoption,exceptADSMs,maybesubjecttopointofservice(POS)chargesiftheyobtainnonemergencycarewithoutappropriatereferralsorauthorizations.Seeyourprogramoption’sguidelinesregardingreferralsandauthorizationsintheGetting Care section.

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BeneficiarieseligibletoseekcarefromaU.S.non-networkprovideroranoverseashostnationprovidermayberequiredtopayforservicesthenfileaclaimwithTRICAREforreimbursement.Reimbursementisbasedonthedatetheservicewasrendered.Regardlessofthecurrencyusedforreimbursement,TRICAREwillnotreimburseforanydifferencesduetochangesincurrencyvalue(e.g., U.S. dollar, host nation currency).

Fileanynecessaryclaimstotheareawhere you live,notwhereyoureceivedthecare.Note:TRICAREForLifebeneficiariesshouldfileclaimsbasedonwheretheyreceivedcare.VisittheWisconsinPhysiciansServiceWebsiteatwww.TRICARE4u.comfordetails.

U.S.non-networkprovidersmaychargeupto15percentabovewhatTRICAREpays(the TRICARE-allowable charge).Youareresponsibletopaythesechargesalongwithanyapplicablecost-shareanddeductibleamounts.

Someoverseasprovidersmaychargemorethan15percentabovetheTRICARE-allowablechargefortheirservices.YoumayberesponsibleforanydifferencebetweentheTRICARE-allowablechargeandthebilledamountaprovidermaycharge,unlessyouusetheservicesofaparticipatingprovider.AparticipatingprovideragreestoaccepttheTRICARE-allowablecharge,plusthepatient’scost-shareaspaymentinfullfortheservicesrendered.Participatingprovidersmayparticipateonaclaim-by-claimbasis.YouarealwaysencouragedtofindthoseproviderswhoagreetoaccepttheTRICARE-allowablechargeandanycost-shareordeductibleamountsforwhichyouareresponsibleaspaymentinfull.


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Who to See for Care

Behavioral Health Care Provider Types

Therearemanytypesofproviderswhodeliverbehavioralhealthcareservicesandsomemayprovidespecificservices.ThefollowingprovidertypesmaybeauthorizedbyTRICARE:

Psychiatrists and Other Physicians: • Theseprovidersmayperformpsychotherapyandcounseling,aswellasmanagemedication.

Clinical Psychologists: • Clinicalpsychologistsperformpsychotherapy,psychologicaltesting,andcounselingservices,butcannotgenerallyprescribemedication.Note:IntheU.S.,somestatesallowpsychologiststoprescribemedications.Contactyourregionalcontractorforguidelinesinyourarea.

Certified Psychiatric Nurse Specialists: • Certifiedpsychiatricnursespecialistsprovidetherapytoindividualswithdiagnosedpsychiatricdisordersortoindividualsatriskforbehavioralhealthproblems.Nursespecialistsmayperformpsychotherapyandmanagemedications.

Licensed Clinical Social Workers: • Master’sdegreelevelclinicalsocialworkerscanperformpsychotherapyandcounselingservices,butcannotprescribemedication.

Certified Marriage and Family Therapists: • Marriageandfamilytherapistsperformindividualcounselingandfamilytherapy,butcannotprescribemedication.Inorderforservicestobecovered,marriageandfamilytherapistsmustbeTRICARE-authorizedprovidersandhaveaparticipationagreementwithTRICARE.

Counselors: • Counselorscanperformtherapeuticcounselingservicesunderthesupervisionofaphysician,butcannotprescribemedication.Youmusthaveareferralfromyourphysiciantovisitabehavioralhealthcarecounselor,licensedorcertifiedmentalhealthcounselor,orapastoralcounselor.

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Selecting a Provider

Findingabehavioralhealthcareprovidermaybeaseasyastalkingtoyourprimarycaremanager(PCM)orfamilyphysician.Youcanalsocontactyourregionalcontractor,localTRICAREServiceCenter(TSC),orlocalTRICAREGlobalRemoteOverseas(TGRO)AlarmCenter(as applicable)forassistance.

Ifyoudon’tknowyourU.S.regionoroverseasarea,youcanfindalistofserviceareasatwww.tricare.mil.

Questions to Ask

Ifyoudecidetoseeabehavioralhealthcareprovider,thereareimportantquestionstoask.Alistofsuggestedquestionsfollows.Note:OverseasbehavioralhealthcareprovidersmayfollowdifferingtreatmentguidelinesthanU.S.providers.

Costs

DoyouparticipateinTRICARE?•

Whatareyourfees,includingchargesformissedsessions?•

Experience

Howlonghaveyoubeenlicensed?•

Howlonghaveyoubeeninpractice?•

Howmuchexperiencehaveyouhadassessingandtreatingmy•particularproblem?

Howmuchexperiencehaveyouhadassessingandtreating•peoplelikeme(e.g., gender, age, ethnic group, disability status)?

Treatment Approach

Howoftenwillwemeet?•

Howlongwillmytreatmenttake?•

Willanyoneelseparticipateinmytreatment(• e.g., spouse, children, or others)?

Whatapproacheswouldyouusetotreatmyproblem?•

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WhathappensifyourapproachesdonothelpmeorIfeelworse?•

WhathappensifIhaveacrisisduringtreatment?•

InformationaboutassistanceinfindingaprovidercanbefoundintheGetting Caresection.Lookforyourbeneficiarytypeandprogramoption.

Before You Travel

Ifyouareplanningtotravelandthinkyoumayneedbehavioralhealthcareservices,makealistofthefollowingcontactinformationfortheareawhereyou’llbetravelingandtakeitwithyou:

YourPCM,primarycareprovider,USFamilyHealthPlan•(USFHP)contact,orexistingbehavioralhealthcareprovider(as applicable)

Localmilitarytreatmentfacility:Visit• www.tricare.mil/mtfforlocations.

LocalTRICAREregionalcontractor(• if applicable)*

LocalTRICAREServiceCenter(TSC):Visit•www.tricare.mil/contactusforU.S.locationsorwww.tricare.mil/overseastscforoverseaslocations.

RegionalBehavioralHealthCareProviderLocatorand•AppointmentAssistanceLine*

LocalTRICAREAreaOffice,TGROAlarmCenter,orthe•PuertoRicoCallCenter(as applicable):SeeFigures7.2,7.3,and7.4intheFor Information and Assistancesectionforcontactinformation.

ApplicableMilitaryMedicalSupportOffice(MMSO)service•pointofcontact(SPOC):SeeFigure7.5intheFor Information and Assistancesection.

Regionalclaimsprocessorandclaims-filingaddressforthearea•whereyoulive:Visitwww.tricare.mil/claimsfordetails.

* See Figure 7.1 in the ForInformationandAssistance section.

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WisconsinPhysiciansService:SeeFigure7.6inthe•For Information and Assistancesection.

Yourotherhealthinsurance(OHI)carrier,ifapplicable•

CanadianForcesHealthFacility:Visit•www.tricare.mil/tlac/canada_cfhf.cfmforlocations.

NearestU.S.EmbassyorConsulate:Visit• www.usembassy.gov forlocations.

ValueOptions:SeeFigure7.6inthe• For Information and Assistancesection.

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Getting CareHowyouaccessbehavioralhealthcaredependsonthreefactors:thetypeofbeneficiaryyouare,yourTRICAREprogramoption,andyourlocation.Thesectionsthatfollowarenamedbybeneficiarytype.LookforthesectionthatappliestothetypeofbeneficiaryyouarethenfollowtheguidelinesforyourspecificTRICAREprogramoption.

About situations: At the beginning of each beneficiary section, you’ll notice one or two brief situations describing common behavioral health concerns. Most of these situations could apply to anyone although some may be more common among military families. If you feel that any of these situations sound familiar, don’t try to diagnose what may be causing the problem. If the problems persist, consider seeking help or urge your loved one to seek help.

Thebeneficiarytypescoveredinthissectionare:

ActiveDutyServiceMember•

ActiveDutyFamilyMember•

NationalGuardorReserveMemberorFamilyMember•

RetiredServiceMemberorFamilyMember•

Medicare-EligibleTRICAREBeneficiary*•

* Medicare is your primary insurer. Follow the guidelines for your Medicare health plan. For details, contact your Medicare plan administrator, call Medicare at 1-800-633-4227, or visit www.medicare.gov. If you are under age 65, covered by Medicare, and also enrolled in TRICARE Prime, Medicare is still your primary insurer unless your Medicare benefits are exhausted. In that event, follow the TRICARE Prime guidelines under “Retired Service Member or Family Member.”

Yourlocation,aswellasyoureligibilitystatus,canalsodeterminehowyouaccessbehavioralhealthcare.Forexample:

US Family Health Plan beneficiaries:• TheUSFamilyHealthPlan(USFHP)isaTRICAREPrimeoptionavailableinsixgeographicareasacrosstheU.S.IfyouareaUSFHPbeneficiary,contactUSFHPfordetailsonbehavioralhealthcareaccessguidelinesat1-800-748-7347orvisitwww.usfamilyhealthplan.org.

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TRICARE-eligible survivors: • Ifyouareaneligibletransitionalsurvivorofadeceasedactivedutysponsor(including National Guard or Reserve members who served on active duty for more than 30 consecutive days),youhavethesamecareaccessandrequirementsasanyactivedutyfamilymember(ADFM)solongasyouremaineligibleforTRICAREtransitionalsurvivorbenefits.

Duringthistransitionalsurvivorperiod,followthebeneficiaryguidelinesunder“ActiveDutyFamilyMember.”Afterthefirstthreeyears,eligiblesurvivingspousescontinuetoreceivesurvivorbenefits,butatretiredfamilymemberrates;theyshouldfollowthebeneficiaryguidelinesunder“RetiredServiceMemberorFamilyMember.”Formoresurvivorbenefitdetails,visitwww.tricare.mil/survivors.

TRICARE-eligible Medal of Honor recipients and eligible •family members:IfyouareaMedalofHonorrecipientandremainonactiveduty,youshouldfollowthebeneficiaryguidelinesunder“ActiveDutyServiceMember,”andyourfamilyshouldfollow“ActiveDutyFamilyMember”guidelines.Ifyouhaveseparatedfromactiveduty,youandyourfamilymembersshouldfollowthebeneficiaryguidelinesunder“RetiredServiceMemberorFamilyMember.”

Whetheryouexperienceabehavioralhealthemergencyorneedoutpatientbehavioralhealthcare,theinformationinthefollowingsectionsprovidesdetailsonwhattodoandwheretofindhelp.

ThefollowingcareaccessguidelinesapplyonlytoyourTRICAREbenefit.Ifyouhaveotherhealthinsurance(OHI),yourOHIisyourprimaryinsurer,andTRICAREpaysaftertheOHI.CheckwithyourOHIforanybehavioralhealthcareauthorizationrequirements.WhentheOHIpaysfirst,TRICAREpriorauthorizationrulesdonotapply.Note:NationalhealthinsuranceprogramsoverseasareconsideredOHI.Ifyouareenrolledinsuchprograms,seekguidancefromanoverseasTRICAREServiceCenter(TSC)beforeobtaininghealthcarefromahostnationprovider.

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Active Duty Service Member

Situation 1: Ever since that truck backfired the other day and I almost hit the deck, I can’t stop thinking about it. I haven’t slept well and every little thing makes me jumpy. what’s wrong with me?

Situation 2: I thought I’d get over losing my buddies by now. how long is sadness supposed to last?

Theseconcernsarenotuncommonamongactivedutyservicemembers.Traumaticexperiencesduringdeploymentcanbetriggeredbyeverydayeventsathome.Inaddition,griefhasnotimetable—howlongitlastsisdifferentforeveryone.However,thereareprovenmethodsfordealingwithtraumaandgriefinpositiveways.

Communicationisanecessity.Keeptalking.Ifyou’veestablishedyourbaseofsupport—friends,family,commanders—usethatsupport.Don’tshutyourselfofffromthoseyouneedandthosewhoneedyou.Communicationisparticularlyvitalduringthelongseparationsmilitaryfamiliesendureduringdeployments.

Ifyoufindcopingwithlife’schallengestobeincreasinglydifficultorifyou’reworriedaboutalovedone,talktoyourprimarycareproviderabouttheproblem.Remember,you’renotaloneandhelpisavailable.

Program Option and Location Determine Care Access

Howyouaccessbehavioralhealthcaredependsonyourprogramoptionandlocation.Asanactivedutyservicemember(ADSM),youmayhavecoverageunderoneofthefollowingprogramoptionsdependingonwhereyouliveorarestationed:

TRICARE Prime: • AvailableinmanyareasintheU.S.

TRICARE Prime Remote (TPR): • AvailableindesignatedareasintheU.S.

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TRICARE Overseas Program (TOP) Prime: • AvailableinmanyareasoutsidetheU.S.

TRICARE Global Remote Overseas (TGRO): • Availableinoverseasremotelocations

Getting Care, Referrals, and Authorizations

Usethefollowingguidelines,listedbyprogramoption,toaccesscaredependingonyourlocation.Ifyouseekbehavioralhealthcarethroughamilitarytreatmentfacility(MTF),referralsorauthorizationsarenotrequired.Ifyouseeknonemergencycarefromacivilianprovider(care outside of an MTF),areferralorauthorizationisrequiredforfitness-for-dutypurposes.

Dependingonyourprogramoption,yourlocalMTF,TRICAREServiceCenter(TSC),TGROAlarmCenter,orTRICAREAreaOffice(TAO)canassistwithbenefitquestions.ContactinformationreferencedinthissectionislistedintheFor Information and Assistancesection.

Note:IfyouandyouraccompanyingfamilymembersliveinCanadaandareenrolledinoreligibleforTOPPrime,youshouldseekspecialtycarethroughyourCanadianForcesHealthFacility.Ifcareisnotavailableatthelocalfacility,allcareisprovidedbycivilianprovidersorfacilities.

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U.S. TRICARE Prime Option ADSMs: Nonemergency Inpatient Admissions

AllnonemergencyinpatientbehavioralhealthcareadmissionsrequirepriorauthorizationfromyourMTFPCMorMMSOSPOC(for TPR beneficiaries).

U.S. TRICARE Prime Option ADSMs: Outpatient Care

YoudonotneedareferraltoreceivebehavioralhealthcareatanMTF.However,forciviliancare,referralsarerequiredfromyourMTFPCM(or MMSO SPOC if enrolled in TPR).Ifnoproviderislistedonyourreferral,youmayobtainhelpwithfindingaproviderorschedulinganappointmentbycallingtheBehavioralHealthCareProviderLocatorandAssistanceLinefortheregioninwhichyouareseekingcare.SeeFigure5.1onthefollowingpageforadditionaloutpatientcaredetails.

U.S. TRICARE Prime Option ADSMs: Emergency Care

In Your Home Area or Traveling in the U.S.

Dial911orgotothenearestemergencyroom.•

Referralsorpriorauthorizationsare• notrequired.*

Contactyourprimarycaremanager(PCM),orMilitary•MedicalSupportOffice(MMSO)servicepointofcontact(SPOC)within24hoursorthenextbusinessday.

While Traveling Overseas

Gotothenearestemergencycarefacility,andcontactthe•localTGROAlarmCenterassoonaspossibleafterseekingcareorpriortomakingpayment.InPuertoRico,callthePuertoRicoCallCenter.

Referralsorpriorauthorizationsare• notrequired.*

* If admitted, work with the facility to obtain a prompt continued stay authorization from your MTF PCM or MMSO SPOC (forTPRbeneficiaries) within 24–72 hours of the admission.

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1. Contact the facility to schedule an appointment.

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TOP Prime and TGRO ADSMs: Emergency Care

In Your Home Area or Traveling Overseas

Gotothenearestemergencycarefacility.Contactyour•MTFprimarycaremanager(PCM)orTGROAlarmCenterassoonaspossibleafterreceivingcareorpriortomakingpayment.*

InPuertoRico,contactthePuertoRicoCallCenter.•

While Traveling in the U.S.

Call911orgotothenearestemergencyroom.*•

Useyouroverseasresidentialaddresswhenreceivingcare•orfilingclaims.

* Referrals or prior authorizations are not required. If admitted, work with the facility to obtain a prompt continued stay authorization from your MTF PCM or TGRO Alarm Center within 72 hours of the admission.

Who to See At Home or Traveling in the U.S. Traveling Overseas

MTF Provider

•Mayself-refertolocalmilitarybehavioralhealthorlifeskillsclinic1

•Referralnot required


•Referralnotrequired

Civilian Provider

•MTFPCMreferralorMMSOSPOCauthorizationis required

•MTFPCMreferralorMMSOSPOCauthorizationis required•ContactlocalTGROAlarmCenterforassistance•InPuertoRico,contactPuertoRicoCallCenter

Figure 5.1U.S. TRICARE Prime Option ADSMs: Outpatient Care

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TOP Prime and TGRO ADSMs: Nonemergency Inpatient Admissions

Allnonemergencyinpatientbehavioralhealthcareadmissionsrequireauthorizationwithin72hoursoftheadmission.WhiletravelingintheU.S.,gotothenearestMTFfornonemergencycare.IftheMTFcannotprovidethecareyouneed,youwillbereferredtoaciviliancareprovider.TolocateanMTF,visitwww.tricare.mil/mtf.Exception:WhilevisitingtheU.S.,ADSMsenrolledtotheLatinAmericaandCanada(TLAC)TGROregionmustcontacttheTLACTGROAlarmCenterat1-800-834-5514toobtainauthorizationsforallnonemergencycare.

Authorizationsforoverseasadmissionsareissuedasfollows:

TOP Prime ADSMs• (except in Puerto Rico):TAOissuestheauthorization.

TOP Prime ADSMs in Puerto Rico:• PuertoRicoCallCenterissuestheauthorization.

TGRO ADSMs:• TGROAlarmCenterissuestheauthorization.

TOP Prime and TGRO ADSMs: Outpatient Care

YoudonotneedareferraltoreceivebehavioralhealthcareatanMTF.However,forciviliancare,referralsorauthorizationsarerequiredfromyourMTFPCMorTGROAlarmCenter(or Puerto Rico Call Center while in Puerto Rico).WhentravelingintheU.S.,gotothenearestMTFforanynecessaryoutpatientcare.IftheMTFcannotprovidethecare,youwillbereferredtoacivilianprovider.TolocateanMTF,visitwww.tricare.mil/mtf.Exception:WhilevisitingtheU.S.,ADSMsenrolledtotheTLACTGROregionmustcontacttheTLACTGROAlarmCenterat1-800-834-5514toobtainpriorauthorizationsforallnonemergencycare.SeeFigure5.2onthefollowingpageforadditionaldetails.

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1. Contact the facility to schedule an appointment. If no MTFs are available in your area, contact the TGRO Alarm Center (orPuertoRicoCallCenterwheninPuertoRico) for assistance.

2. If the MTF cannot provide the care, you will be referred to an appropriate civilian provider. While visiting the U.S., ADSMs enrolled to the TLAC TGRO area must contact the TLAC TGRO Alarm Center at 1-800-834-5514 to obtain prior authorizations for all nonemergency care (includesoutpatientcare).

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Who to See At Home or Traveling Overseas Traveling in the U.S.

MTF Provider


•Referralorpriorauthorizationnotrequired

•Mayself-refertolocalmilitarybehavioralhealthorlifeskillsclinic1,2

•Referralorpriorauthorization notrequired

Civilian Provider

•MTFPCM,TGROAlarmCenter,orPuertoRicoCallCenterreferralorpriorauthorizationrequired•ContactlocalTGROAlarmCenterorTSCtofindaprovider

•MTForTGROAlarmCenterreferralorpriorauthorizationrequired•Afterreceivingreferral,youmaycallregionalBehavioralHealthCareProviderLocatorandAssistanceLine

Figure 5.2TOP Prime and TGRO ADSMs: Outpatient Care Ac

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Active Duty Family Member

Situation 1: my granddaughter began wetting the bed after her parents were deployed. she hasn’t done that since she was potty trained. six-year-olds aren’t supposed to wet the bed, are they?

Situation 2: for a while, everything was great after my husband came back. It was like we were kids again, holding hands wherever we went. now he hardly talks to me, except to argue. what’s happening to us?

Deployments,orlengthyseparationsofanykind,arestressfulfortheentirefamily.Althoughveryyoungchildrenmaynotfullyunderstandthedangersinvolvedifaparentisdeployed,theycansensetheanxietyofothers.Justseeingtroublingnewsfootagecanbeemotionallyupsetting,andnotjustforachild.

Whenfamiliesarereunited,it’snotuncommonforthemtoexperiencea“honeymoon”period,duringwhicheverythingseemsfine.Butseveralmonthsaftertheservicememberreturns,theexperiencesheorshefacedwhileawaycombinedwiththefrustrationsofeverydaylivingcancreatestress.

Timeisagreathealer,butsometimesit’snotenough.Youshouldn’toverreactifafamilymemberappearstroubled,butyoualsoshouldn’tassumethatignoringaproblemwillmakeitgoaway.Ifdiscussionwithyourlovedonedoesn’thelp,talktoyourdoctor.


Howyouaccessbehavioralhealthcaredependsonyourprogramoptionandlocation.Asanactivedutyfamilymember(ADFM),youmayhavecoverageunderoneofthefollowingprogramoptionsdependingonwhereyoulive:


TRICARE Prime Remote for Active Duty Family Members •(TPRADFM):AvailableindesignatedareasintheU.S.toeligiblefamilymemberswhoseactivedutysponsorsareenrolledinTRICAREPrimeRemote.

TRICARE Standard and TRICARE Extra: • AvailableintheU.S.

TRICARE Overseas Program (TOP) Prime:* • AvailableinmanyareasoutsidetheU.S.

TRICARE Global Remote Overseas (TGRO):* • Availableinoverseasremotelocations.

TRICARE Overseas Program (TOP) Standard: • AvailableoutsidetheU.S.

* Family member eligibility is usually contingent upon command sponsorship for these programs. Note: National Guard and Reserve members and their family members who are covered as ADFMs under the Transitional Assistance Management Program (TAMP) are not eligible for these programs.


Usethefollowingguidelines,listedbyprogramoption,toaccesscaredependingonwhereyouliveortravel.Priorauthorizationmayberequiredforcertainservices.Forpriorauthorizationdetailsforyourarea,contactyourregionalcontractor,TRICAREServiceCenter(TSC),orTRICAREAreaOffice(TAO).IfyouareenrolledinaTRICAREPrimeprogramoption,followtherulesofyourprogramtoavoidpointofservice(POS)fees.Visitwww.tricare.milfordetails.Note:U.S.beneficiariesseekingcareoverseasshouldnotifytheirregionalcontractorassoonaspossible.ContactinformationreferencedinthissectionislistedintheFor Information and Assistancesection.

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U.S. TRICARE Prime Option ADFMs: Emergency Care*




Gotothenearestemergencycarefacilityorcontactthe•localTGROAlarmCenterforassistance.

* Referrals or prior authorizations are not required for emergency care. Contact your primary care manager (PCM) or primary care provider within 24 hours or the next business day for care coordination. If admitted, work with the facility to obtain a prompt continued stay authorization from your regional contractor within 24–72 hours of the admission.

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U.S. TRICARE Prime Option ADFMs: Nonemergency Inpatient Admissions

Allnonemergencyinpatientbehavioralhealthcareadmissions requirepriorauthorizationfromyourregionalcontractor.

U.S. TRICARE Prime Option ADFMs: Outpatient Care

Foryourfirsteightoutpatientbehavioralhealthcarevisitsperbeneficiaryperfiscalyear(FY),referralsfromyourPCMarenotrequired.However,aPCMorphysicianreferralis requiredfor all visitstocounselorswhorequirephysiciansupervision(e.g., behavioral health care counselors, licensed or certified mental health counselors, or pastoral counselors).Ifnoproviderislistedonyourreferral,youmayobtainhelpwithfindingaproviderorschedulinganappointmentbycallingtheBehavioralHealthCareProviderLocatorandAssistanceLinefortheregioninwhichyouareseekingcare.Forotheroutpatientservices,priorauthorizationmayberequired.SeeFigure5.3foradditionaldetails.

1. The FY is October 1–September 30.2. While traveling, routine care is not normally authorized. To avoid POS charges,

you must see a network provider in the U.S. When traveling overseas, contact your PCM or regional contractor when seeking care to avoid POS charges.


MTF or Civilian Provider

•Mayself-refertoanetworkproviderforfirst8visitsperbeneficiaryperFY1,2

•Priorauthorizationfromregionalcontractorrequiredforninthandanysubsequentvisits

•Mayself-refertoanyTRICARE-authorizedproviderforfirst8visitsperbeneficiaryperFY1,2

•Priorauthorizationfromregionalcontractorrequiredforninthandanysubsequentvisits•ContactlocalMTF,TSC,orTAOtofindaprovider

Figure 5.3U.S. TRICARE Prime Option ADFMs: Outpatient Care

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TOP Prime and TGRO ADFMs: Nonemergency Inpatient Admissions

Allnonemergencyinpatientbehavioralhealthcareadmissionsrequireauthorizationwithin72hoursoftheadmission.Authorizationsareissuedasfollows:

TOP Prime ADFMs• (overseas admissions, except in Puerto Rico):TAOissuestheauthorization.

TOP Prime ADFMs in Puerto Rico:• PuertoRicoCallCenterissuestheauthorization.

TGRO ADFMs• (overseas admissions):TGROAlarmCenterissuestheauthorization.

All ADFMs traveling in the U.S.:• ValueOptionsissuestheauthorization.

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TOP Prime and TGRO ADFMs: Emergency Care

In Your Home Area or Traveling Overseas

Gotothenearestemergencycarefacility.*•

ContactyourPCMorTGROAlarmCenterassoonas•possibleafterreceivingcareorpriortomakingpayment.InPuertoRico,contactthePuertoRicoCallCenter.*


Dial911orgotothenearestemergencyroom.*•

Useyouroverseasresidentialaddresswhenreceivingcare•orfilingclaimstoWisconsinPhysiciansService.

* Referrals or prior authorizations are not required for emergency care. If admitted, work with the facility to obtain a prompt continued stay authorization from your MTF PCM or TGRO Alarm Center within 72 hours of the admission.

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TOP Prime and TGRO ADFMs: Outpatient Care

Foryourfirsteightoutpatientbehavioralhealthcarevisitsperbeneficiaryperfiscalyear(FY),referralsfromyourPCMorTGROAlarmCenterarenotrequired.However,aPCM,TGROAlarmCenter,orphysicianreferralis requiredfor all visitstocounselorswhorequirephysiciansupervision(e.g., behavioral health care counselors, licensed or certified mental health counselors, or pastoral counselors).WhentravelingintheU.S.,youmayobtainhelpwithfindingaproviderorschedulinganappointmentbycallingtheBehavioralHealthCareProviderLocatorandAssistanceLinefortheU.S.regioninwhichyouareseekingcare.Forotheroutpatientservices,priorauthorizationmayberequired.SeeFigure5.4foradditionaldetails.

1. TOP Prime-enrolled ADFMs living in Canada who accompany their active duty sponsor should seek specialty care through their Canadian Forces Health Facility. If care is not available at the local facility, all care is provided by civilian providers or facilities.

2. POS charges may apply in your area for nonemergency care without appropriate authorization. Contact your local TSC or TAO for details. The FY is October 1–September 30.

Who to See At Home1 or Traveling Overseas Traveling in the U.S.

MTF or Civilian Provider

•Mayself-refertoanyTRICARE-authorizedproviderforfirst8visitsperbeneficiaryperFY2

•PriorauthorizationrequiredfromPCMorTGROAlarmCenterforninthandanysubsequentvisits•InPuertoRico,contactPuertoRicoCallCenter

•Mayself-refertoaTRICAREnetworkproviderforfirst8visitsperbeneficiaryperFY2

•PriorauthorizationfromValueOptionsrequired forninthandanysubsequentvisits

Figure 5.4TOP Prime and TGRO ADFMs: Outpatient Care

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U.S. TRICARE Standard ADFMs: Nonemergency Inpatient Admissions

All nonemergencyinpatientbehavioralhealthcareadmissionsrequirepriorauthorizationfromyourregionalcontractor.

U.S. TRICARE Standard ADFMs: Outpatient Care

Foryourfirsteightoutpatientbehavioralhealthcarevisitsperbeneficiaryperfiscalyear(FY),priorauthorizationis notrequired.However,aphysicianreferralis requiredfor all visitstocounselorswhorequirephysiciansupervision(e.g., behavioral health care counselors, licensed or certified mental health counselors, or pastoral counselors).Forotheroutpatientservices,priorauthorizationfromyourregionalcontractormayberequired.SeeFigure5.5onthefollowingpageforadditionaldetails.

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U.S. TRICARE Standard ADFMs: Emergency Care


Call911orgotothenearestemergencyroom.*•



Forassistance,contactthenearestMTF,TSC,TAO,U.S.•EmbassyorConsulate,orvisityourTAO’sWebsite.

* Prior authorizations are not required for emergency care. If admitted, work with the facility to obtain a prompt continued stay authorization from your regional contractor within 24–72 hours of the admission. TRICARE Extra is not available overseas. For care received overseas, you will pay TRICARE Standard cost-shares.

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1. TRICARE Extra is not available overseas. For care received overseas, you will pay TRICARE Standard cost-shares.

2. Contact the nearest MTF, TSC, TAO, U.S. Embassy or Consulate, or visit your local TAO’s Web site to find a provider. The FY is October 1–September 30.

TOP Standard ADFMs: Emergency Care*

In TRICARE Eurasia-Africa

Gotothenearestemergencycarefacility.•

ContactlocalMTF,TSC,orTAOtofindaprovider.•

In TRICARE Latin America and Canada†


ContactValueOptionstoobtainpriorauthorizationfor•inpatientadmissions,partialhospitalization,andresidentialtreatmentcenterservicesinU.S.territories.

In TRICARE Pacific


ContactyourlocalTSCorTAOforassistance.•


Call911orgotothenearestemergencyroom.• ‡

* Prior authorizations are not required for emergency care. If admitted, work with the facility to obtain a prompt continued stay authorization from the TAO within 72 hours of the admission.

† In Guantanamo Bay, seek care from the U.S. Naval Hospital.

‡ Use your overseas residential address when receiving care or filing claims.

Who to See At Home or Traveling in the U.S. Traveling Overseas1

MTF or Civilian Provider(MTF care is on a space-available basis)



•Mayself-refertoahostnationproviderforfirst8visitsperbeneficiaryperFY2


Figure 5.5U.S. TRICARE Standard ADFMs: Outpatient Care

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TOP Standard ADFMs: Nonemergency Inpatient Admissions

All nonemergency inpatientbehavioralhealthcareadmissionsrequireauthorizationwithin72hoursoftheadmissionfromtheTAOforoverseasadmissions(except in Puerto Rico)orfromValueOptionsforadmissionsintheU.S.orPuertoRico.

TOP Standard ADFMs: Outpatient Care

Priorauthorizationisnotrequiredforoutpatientcare.However,aphysicianreferralis required for all visits tocounselorswhorequirephysiciansupervision (e.g., behavioral health care counselors, licensed or certified mental health counselors, or pastoral counselors).CheckwithyourlocalTSCorTAOforphysicianreferralorauthorizationdetails.SeeFigure5.6foradditionaldetails.

1. Contact the nearest MTF, TSC, TAO, U.S. Embassy or Consulate, or visit your local TAO’s Web site to find a provider.

2. To find a provider, contact the nearest MTF or TSC or visit www.tricare.mil/findaprovider.

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•Mayself-refertoahostnationprovider1

•Priorauthorizationnotrequired

•Mayself-refertoanyTRICARE-authorizedprovider2


Figure 5.6TOP Standard ADFMs: Outpatient Care

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National Guard or Reserve Member or Family Member

Situation 1: I’m exhausted all the time. I sleep, but not enough, I guess. It’s really hard for me to follow what people are saying and I’m messing up at work. maybe some sleeping pills will help me rest and then I’ll feel better.

Situation 2: The other day a car cut me off in the parking lot and dad blew up! I didn’t know what to do when he charged out of the car, ran over to the other car, and started screaming at the driver through the window. dad’s always been so cool and controlled. I was very scared. when he came back to our car, he kept saying everything’s okay. but is it?

Therecouldbeanumberofreasonsforsevereexhaustion,andsomeonesufferingfromsuchasymptomshouldn’ttrytodiagnosewhat’swrongorexplainawaythecause.Extremeandpersistentfatiguecouldhaveaphysicaloremotionalsource.It’samistaketotryand“treat”thesymptomsonyourown.

Overreactionstoroutinesituationsaren’talwaysexpressedthroughanger.Apersoncouldlaughorcryatanentirelyinappropriatemoment.Suchbehavioralchangescanbewarningsignsofemotionalorphysicaldistress.Ifyouorsomeoneyouknowisexperiencingunusualfeelingsorbehavior,discussyourconcernswithaprofessionalqualifiedtodiagnosesymptomsandhelpyouworktowardrelievingthem.

Activation Status Determines TRICARE Eligibility and Care Access

Pre-Activation Benefit

Ifyouareissueddelayed-effective-dateactivedutyordersformorethan30consecutivedaysinsupportofacontingencyoperation,youandyourfamilymaybecomeeligibleforTRICAREpre-activationbenefitsbeginningonthedateyourorderswereissuedor90daysbeforeyoureporttoactiveduty,whicheverislater.Ifyourordersarecancelledbeforeyoureportforactiveduty,TRICAREcoverageendsforyouandyourfamilyonthedatetheordersarecancelled.IfyouareeligibleforTRICAREpre-activationbenefits,youhave

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accesstothesamebenefitsasanactivedutyservicemember(ADSM)andyoureligiblefamilymembershaveaccesstothesamebenefitsasactivedutyfamilymembers(ADFMs).Seethebehavioralhealthcareaccessguidelinesunder“ActiveDutyServiceMember”and“ActiveDutyFamilyMember”respectively.

During Activation

YouhaveaccesstothesamebenefitsasanADSMandshouldseekbehavioralhealthcareservicesfromamilitarytreatmentfacility(MTF)orsimilarmilitary-operatedhealthfacility.Forbehavioralhealthcareaccessguidelinesduringyouractivationperiod,seeyourprogramoptionunder“ActiveDutyServiceMember”earlierinthissection.

Your Family’s Eligibility

Dependingonthelengthofyouractivation,yourfamilymembersmaybeeligibleforADFMbenefits.Contactyourservicepersonnelofficefordetails.ForADFMbehavioralhealthcareaccessguidelines,see“ActiveDutyFamilyMember.”

When Deactivated

ContactyourservicepersonnelofficeorvisittheGuardandReserveWebPortalathttps://www.dmdc.osd.mil/Guard-ReservePortaltodetermineyoureligibilityforthefollowingprograms:

Transitional Assistance Management Program (TAMP): • Provides180daysofcoverageforyouandyoureligiblefamilymembersbeginningonyourreleasefromactivedutydate.UnderTAMP,youmayenrollinTRICAREPrimeorTRICAREOverseasProgram(TOP)Prime(if you live overseas in a TRICARE Prime Service Area).IfyouchoosenottoenrollinaTRICAREPrimeoption,youmaybecoveredunderTRICAREStandardandTRICAREExtraorTOPStandard(if you live overseas).IfcoveredunderTAMP,youandyourfamilymembersareconsideredADFMsduringtheTAMP-eligibleperiodandshouldfollowtheguidelinesforyourprogramoptionunder“ActiveDutyFamilyMember.”

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Continued Health Care Benefit Program (CHCBP): • OncetheTAMPperiodends(or within 60 days of your separation date if you are not eligible for TAMP),youandyoureligiblefamilymemberscanelectCHCBPcoverage,whichprovidesbetween18to36months(depending on eligibility)ofpurchased,premium-basedhealthcarecoveragein90-dayincrements.YoumustcontinuepayingyourmonthlypremiumstokeepCHCBPcoverage.CHCBPoffersbenefitssimilartoTRICAREStandardandTRICAREExtra.

CHCBPbeneficiariesshouldfollowthebehavioralhealthcareaccessguidelinesinthis“NationalGuardorReserveMemberorFamilyMember”section.ForotherCHCBPdetails,call1-800-444-5445.Note:MTFcareisavailabletoCHCBPbeneficiariesonlyintheeventofanemergency.

TRICARE Reserve Select (TRS): • Ifyouandyourfamilymembersqualify,TRSprovidescoveragesimilartoTRICAREStandardandTRICAREExtra.YoumustpaymonthlypremiumstomaintainTRScoverage.Toapplyonline,visittheTRSWebsiteathttps://www.dmdc.osd.mil/appj/trs.Fordetailscontactyourregionalcontractor(U.S. beneficiaries)orValueOptions(overseas beneficiaries).TRSbeneficiariesshouldfollowthebehavioralhealthcareaccessguidelinesinthis“NationalGuardorReserveMemberorFamilyMember”section.

Note:IfyouareaNationalGuardorReservememberwhowasactivatedbyfederalordersandservedonactiveduty,youmayqualifyforveteranstatusforDepartmentofVeteransAffairs(VA)purposes.FordetailsaboutyourpossibleeligibilityforVAbenefits,contactyourregionalVAmedicalcenter.Visitwww.va.govforlocations.IfyouqualifyforbothVAandTRICAREbenefits,youmayseekcareundereitherprogram.

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Location Determines Care Access

Yourprogramoptionandlocationdetermineyourcareaccess.ThefollowingguidelinesareforTRICARE-eligibleNationalGuardandReservememberswhoarenot activated or covered under TAMP.Inthiscase,youandyoureligiblefamilymembersarecoveredundereither:

CHCBP: • AvailableintheU.S.andoverseas

TRS: • AvailableintheU.S.andoverseas

Underbothplans,youcanseeanyTRICARE-authorizedprovider.However,youpayreducedcostswhenyouseeaTRICAREnetworkprovider,whereavailable.


Usethefollowingguidelinestoaccesscaredependingonwhereyouliveortravel.Note:U.S.beneficiariesseekingcareoverseasshouldnotifytheirregionalcontractorassoonaspossibleafterreturningtotheU.S.ContactinformationreferencedinthissectionislistedintheFor Information and Assistancesection.

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CHCBP and TRS Beneficiaries: Emergency Care

In the U.S.

Dial911orgotothenearestemergencyroom.*•

Overseas


ContactthenearestTRICAREServiceCenter(TSC),•TRICAREAreaOffice(TAO),U.S.EmbassyorConsulate,orvisityourlocalTAO’sWebsitetofindaprovider.

* Prior authorizations are not required for emergency care. If admitted, work with the facility to obtain a prompt continued stay authorization from your regional contractor (U.S.beneficiaries) or the TAO (overseasbeneficiaries) within 24–72 hours of the admission.

www.tricare.mil

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CHCBP and TRS Beneficiaries: Nonemergency Inpatient Admissions

Allnonemergencyinpatientbehavioralhealthcareadmissionsrequirepriorauthorization.PriorauthorizationsforadmissionsofU.S.TRSbeneficiariesareissuedbytheregionalcontractor.PriorauthorizationsforadmissionsofoverseasTRSbeneficiariesandCHCBPbeneficiariesareissuedbyValueOptions.

CHCBP and TRS Beneficiaries: Outpatient Care

Foryourfirsteightoutpatientbehavioralhealthcarevisitsperbeneficiaryperfiscalyear(FY),priorauthorizationisnotrequired.However,aphysicianreferralis requiredfor all visitstocounselorswhorequirephysiciansupervision(e.g., behavioral health care counselors, licensed or certified mental health counselors, or pastoral counselors).

PriorauthorizationsforU.S.TRSbeneficiariesseekingcareintheU.S.oroverseasareissuedbytheregionalcontractor.PriorauthorizationsforCHCBPbeneficiaries(U.S. or overseas)areissuedbyValueOptions.Priorauthorizationsmayalsoberequiredforotheroutpatientservices.CheckwithyourregionalcontractororyourlocalTSCorTAOfordetails.SeeFigure5.7onthefollowingpageforadditionaloutpatientcaredetails.

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1. MTF outpatient care is not available to CHCBP beneficiaries. 2. The FY is October 1–September 30. Contact the nearest MTF, TSC, TAO,

U.S. Embassy or Consulate, or visit your local TAO’s Web site to find a provider.3. TRS beneficiaries residing overseas do not require prior authorizations for

outpatient care.

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Who to See In the U.S. Overseas

MTF1 or Civilian Provider

•Mayself-refertoanyTRICARE-authorizedproviderperbeneficiaryperFYforfirst8visits2

•Priorauthorizationrequiredforninthandanysubsequentvisits

•Mayself-refertoahostnationproviderperbeneficiaryperFYforfirst8visits2,3

•Priorauthorizationrequiredforninthandanysubsequentvisits3

Figure 5.7CHCBP and TRS Beneficiaries: Outpatient Care NA

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Retired Service Member or Family Member

Situation 1: my wife has been feeling a little down, but now she doesn’t want to get out of bed in the morning. I have to coax her to get up. she used to take such good care of herself. And me. now she doesn’t even care about her appearance. something’s definitely wrong.

Situation 2: Ever since I retired, I feel out of place. does what I do matter anymore?

Everyonegetsdowninthedumpsnowandthen.Evenlifechangescancausestress,anxiety,ordepression,whichisnormal.Butwhenthe“blues”persistandstartlimitingaperson’sabilitytofunctionnormally,itcouldbeasignofamoreseriousconditionthatrequiresprofessionalassistance.


Asaretiredservicememberorretireefamilymember,youmaybecoveredbyoneofthefollowingprograms:


TRICARE Standard and TRICARE Extra: • AvailableintheU.S.

TRICARE Overseas Program (TOP) Standard: • Availableoverseas

Note:Ifyouareaservicememberwhoseparatedorwasreleased(but did not retire)fromactivedutyserviceduetoadiseaseordisabilityconnectedtoyourmilitaryservice,youmayalsobeeligibleforDepartmentofVeteransAffairs(VA)benefitsinadditiontoyourTRICAREbenefits.Ifeligible,youcanreceivecareundereitherprogram.ForVAbenefiteligibilitydetails,contactyourregionalVAmedicalcenter.

IfyouoraTRICARE-eligiblefamilymemberisalsoeligibleforMedicarebenefits,see“Medicare-EligibleTRICAREBeneficiary”laterinthissectionforcareaccessguidelines.

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Usethefollowingguidelines,listedbyprogramoption,toaccesscaredependingonwhereyouliveortravel.Priorauthorizationisrequiredforcertainservices.Forpriorauthorizationdetailsforyourarea,contactyourregionalcontractor,TRICAREServiceCenter(TSC),orTRICAREAreaOffice(TAO).IfyouareenrolledinTRICAREPrime,followtherulesofyourprogramtoavoidpointofservice(POS)fees.Fordetails,visitwww.tricare.mil.

Note:U.S.beneficiariesseekingcareoverseasshouldnotifytheirregionalcontractorassoonaspossible.ContactinformationreferencedinthissectionislistedintheFor Information and Assistancesection.

U.S. TRICARE Prime Retirees and Families: Nonemergency Inpatient Admissions

Allnonemergencyinpatientbehavioralhealthcareadmissionsrequirepriorauthorizationfromyourregionalcontractor.

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U.S. TRICARE Prime Retirees and Families: Emergency Care*




Gotothenearestemergencycarefacility.• †

* Referrals or prior authorizations are not required for emergency care. Contact your primary care manager (PCM) within 24 hours or the next business day. If admitted, work with the facility to obtain a prompt continued stay from your regional contractor within 24–72 hours of the admission.

† Contact the nearest military treatment facility (MTF), TRICARE Service Center (TSC), TRICARE Area Office (TAO), U.S. Embassy or Consulate, or visit your local TAO’s Web site to find a provider.

www.tricare.mil

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U.S. TRICARE Prime Retirees and Families: Outpatient Care

Foryourfirsteightoutpatientbehavioralhealthcarevisitsperbeneficiaryperfiscalyear(FY),referralsfromyourPCMarenotrequired.However,aPCMorphysicianreferralis required for all visitstocounselorswhorequirephysiciansupervision(e.g., behavioral health care counselors, licensed or certified mental health counselors, or pastoral counselors).Priorauthorizationfromyourregionalcontractormayberequiredforotheroutpatientservices.SeeFigure5.8foradditionaldetails.

1. The FY is October 1–September 30. Contact the nearest MTF, TSC, TAO, U.S. Embassy or Consulate, or visit your local TAO’s Web site to find a provider.

2. While traveling, routine care is not authorized and POS charges may apply. Contact your PCM or regional contractor when seeking care out of your home area.



•Mayself-refertoaTRICAREnetworkproviderforfirst8visitsperbeneficiaryperFY1,2


•Mayself-refertoahostnationproviderforfirst8visitsperbeneficiaryperFY1,2


Figure 5.8U.S. TRICARE Prime Retirees and Families: Outpatient Care

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U.S. TRICARE Standard Retirees and Families: Nonemergency Inpatient Admissions

Allnonemergencyinpatientbehavioralhealthcareadmissionsrequirepriorauthorizationfromyourregionalcontractor.

U.S. TRICARE Standard Retirees and Families: Outpatient Care

Foryourfirsteightoutpatientbehavioralhealthcarevisitsperbeneficiaryperfiscalyear(FY),priorauthorizationisnotrequired.However,aphysicianreferralis requiredfor all visitstocounselorswhorequirephysiciansupervision(e.g., behavioral health care counselors, licensed or certified mental health counselors, or pastoral counselors).Priorauthorizationfromyourregionalcontractormayberequiredforotheroutpatientservices.SeeFigure5.9onthefollowingpageforadditionaldetails.

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U.S. TRICARE Standard Retirees and Families: Emergency Care*


Call911orgotothenearestemergencyroom.•

While Traveling Overseas†


Contactthenearestmilitarytreatmentfacility(MTF),•TRICAREServiceCenter(TSC),TRICAREAreaOffice(TAO),U.S.EmbassyorConsulate,orvisityourlocalTAO’sWebsitetofindaprovider.

* Prior authorizations are not required for emergency care. If admitted, work with the facility to obtain a prompt continued stay authorization from your regional contractor within 24–72 hours of the admission.

† TRICARE Extra is not available overseas. For care received overseas, you will pay TRICARE Standard cost-shares.

www.tricare.mil

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1. TRICARE Extra is not available overseas. For care received overseas, you will pay TRICARE Standard cost-shares.

2. The FY is October 1–September 30. Contact the nearest MTF, TSC, TAO, U.S. Embassy or Consulate, or visit your local TAO’s Web site to find a provider.

Who to See At Home or Traveling in the U.S. Traveling Overseas1






Figure 5.9U.S. TRICARE Standard Retirees and Families:Outpatient Care

TOP Standard Retirees and Families: Emergency Care*



In TRICARE Latin America and Canada


In Guantanamo Bay: • SeekcarefromtheU.S.NavalHospital.

In TRICARE Pacific




Useyouroverseasresidentialaddresswhenreceivingcare•orfilingclaims.

* Prior authorizations are not required for emergency care. If admitted, work with the facility to obtain a prompt continued stay authorization from your local TRICARE Service Center (TSC) or TRICARE Area Office (TAO) within 72 hours of the admission.

† Contact your local military treatment facility (MTF), TSC, or TAO to find a provider.

TOP Standard Retirees and Families: Nonemergency Inpatient Admissions

Allnonemergencyinpatientbehavioralhealthcareadmissionsrequireauthorizationwithin72hoursoftheadmission.TheTAOissuesauthorizationsforoverseasadmissions.ValueOptionsissuesauthorizationsforU.S.admissions(includes partial hospitalization and residential treatment centers, where available).

TOP Standard Retirees and Families: Outpatient Care

Priorauthorizationisnotrequiredforoutpatientcare.However,aphysicianreferralis requiredfor all visitstocounselorswhorequirephysiciansupervision(e.g., behavioral health care counselors, licensed or certified mental health counselors, or pastoral counselors).SeeFigure5.10foradditionaldetails.

1. Contact the nearest MTF, TSC, TAO, U.S. Embassy or Consulate, or visit your local TAO’s Web site to find a provider. The FY is October 1–September 30.

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•Mayself-refertoahostnationprovider1


•Mayself-refertoanyTRICARE-authorizedprovider1


Figure 5.10TOP Standard Retirees and Families: Outpatient Care

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Medicare-Eligible TRICARE Beneficiary

Situation: what good am I to anyone stuck in this wheelchair? I’m so dependent on my daughter. wouldn’t she be better off without this burden?

Dealingwithadisabilityortheweaknessthatoftencomeswithagecantakeitstollonthepersonsufferingfromtheaffliction,theirfamilymembers,andcaregivers.Ifyouorafamilymemberexperiencesfeelingsofhopelessness,worthlessness,orlosetheabilitytocopewithdailyfrustrationsandsetbacks,helpisavailable.Talktoyourfamilyphysician.Heorshemaybeabletoassistorreferyoutoabehavioralhealthcareprovider.

In the U.S. and its territories:*Intheselocations,MedicareisyourprimaryinsurerandyoumustfollowMedicareguidelinesforaccessingcare.TRICAREForLife(TFL)isyoursecondaryinsurer,unlessyouhaveotherhealthinsurance(OHI).IfyouhaveOHI,TRICAREpaysafterbothMedicareandtheOHI.

WhenMedicareistheprimarypayerforoutpatientorinpatientbehavioralhealthcareservices,TRICAREdoesnotrequirereferralsorpriorauthorizations.However,ifTRICAREbecomestheprimarypayer(e.g., Medicare benefits are exhausted, Medicare is unavailable, services or providers are not covered by Medicare),TRICARE’spriorauthorizationrulesapply.Visitwww.tricare.mil/tflfordetails.Note:Whenfilingclaims,filethemwiththeTFLclaimsprocessor,WisconsinPhysiciansService(WPS).Forcontactinformation,seeFigure7.6intheFor Information and Assistance section.

Outside the U.S. and its territories:*EventhoughyouareaMedicare-eligiblebeneficiary,Medicaredoesnotpayforservicesintheselocations.UnlessyouhaveOHI,TRICAREistheprimarypayerunderTFL,andyouareresponsibleforthesameannualdeductibleandcost-sharesasaTRICAREStandardretiree.

* The U.S. territories are American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the Virgin Islands.

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Note:IfaprivateinsurancecompanyhandlesyourMedicareplan(e.g., Medicare advantage plan),orifyouhaveOHI,contactthatcarrierfordetails.ContactinformationreferencedinthissectioncanbefoundintheFor Information and Assistancesection.

Getting Care and Authorizations

U.S. TFL Beneficiaries: Nonemergency Inpatient Admissions

WhenTRICAREisyourprimaryinsurer,allnonemergencyinpatientbehavioralhealthcareadmissionsoverseasorintheU.S.anditsterritoriesrequirepriorauthorizationfromyourregionalcontractor(includes partial hospitalization and residential treatment center services, where available).

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In Your Home Area or Traveling in the U.S.†




Contactthenearestmilitarytreatmentfacility(MTF),•TRICAREServiceCenter(TSC),TRICAREAreaOffice(TAO),orU.S.EmbassyorConsulatetofindaprovider.

* Prior authorizations are not required by TRICARE for emergency care. However, if you are admitted and when TRICARE is the primary payer, work with the facility to obtain a prompt continued stay authorization from your regional contractor within 24–72 hours of the admission.

† Includes care received in U.S. territories.

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U.S. TFL Beneficiaries: Outpatient Care

WhenMedicareistheprimarypayer,TRICAREdoesnotrequirepriorauthorizationforoutpatientcare.

HoweverwhenTRICAREistheprimarypayer:

Priorauthorizationis• notrequiredforthefirsteightoutpatientbehavioralhealthcarevisitsperbeneficiaryperfiscalyear(FY).

Aphysicianreferral• is required for all visitstocounselorswhorequirephysiciansupervision(e.g., behavioral health care counselors, licensed or certified mental health counselors, or pastoral counselors).

Priorauthorization• is requiredforanyvisitsbeyondthefirsteightself-referredoutpatientbehavioralhealthcarevisitsperbeneficiaryperFY.

Priorauthorizationfromyourregionalcontractormayberequiredforotheroutpatientservicesreceived.SeeFigure5.11foradditionaldetails.

1. The FY is October 1–September 30. Contact the nearest MTF, TSC, TAO, or the nearest U.S. Embassy or Consulate to find a provider.

Who to SeeAt Home or Traveling in the U.S. or in U.S. Territories

Traveling Overseas

Civilian Provider

•Medicareisyourprimarypayer•RefertoMedicareguidelines•SeekcarefromanyMedicare-participatingornonparticipatingprovider•PriorauthorizationsnotrequiredfromregionalcontractorunlessTRICAREpaysfirst


•Priorauthorizationsrequiredfromregionalcontractorforninthandanysubsequentvisits•FileclaimsdirectlywithWPS

Figure 5.11U.S. TFL Beneficiaries: Outpatient Care

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Overseas TFL Beneficiaries: Nonemergency Inpatient Admissions

WhenTRICAREisyourprimaryinsurer,allnonemergencyinpatientbehavioralhealthcareadmissions requireauthorizationfromyourTAOwithin72hoursoftheadmission(includes partial hospitalization and residential treatment center services, where available).

Overseas TFL Beneficiaries: Emergency Care*



Ifunabletoreceivecare,contactthelocalMTFor•TRICAREAreaOffice(TAO)Eurasia-AfricaforreferraltoaU.S.behavioralhealthcarefacility.

In TRICARE Latin America and Canada


IfunabletoreceivecareinPuertoRico,ValueOptionsmay•referyoutoaU.S.behavioralhealthcarefacility.

In TRICARE Pacific


Traveling in the U.S.


Medicarebecomesyourprimaryinsurer.Useyouroverseas•addresswhenreceivingcareorfilingclaims.

* Prior authorization for emergency care is only required by TRICARE when admitted or for continued stay and if TRICARE is the primary payer. File claims for care received with WPS.

† To find a provider, contact your local TRICARE Service Center (TSC) or TAO.

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Overseas TFL Beneficiaries: Outpatient Care

WhenMedicareistheprimarypayer,TRICAREdoesnotrequirepriorauthorizationforoutpatientcare.

WhenTRICAREistheprimarypayer,priorauthorizationisnotrequired;however,aphysicianreferralis required for all visitstocounselorswhorequirephysiciansupervision(e.g., behavioral health care counselors, licensed or certified mental health counselors, or pastoral counselors).SeeFigure5.12foradditionaloutpatientcaredetails.


Civilian Provider

•Priorauthorizationnotrequired•ContactnearestTSC,TAO,orU.S.EmbassyorConsulatetofindaprovider

•SeekcarefromanyMedicare-participatingornonparticipatingprovider•RefertoMedicareguidelines

Figure 5.12Overseas TFL Beneficiaries: Outpatient Care

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Your Right to Privacy

Medical Records and Privacy

TRICAREtakestheresponsibilityofprotectingyourmedicalrecordsseriously.Yourmedicalrecordsmaybepaperrecordsstoredatamilitarytreatmentfacility(MTF)ortheofficeofaTRICARE-authorizedorUSFamilyHealthPlanprovider.OrtheymaybeelectronicrecordsstoredintheMilitaryHealthSystem’sdatabase.Nomatterwhereyourrecordsarelocated,theuseanddisclosureofmedicalinformationisregulatedbyTRICAREpolicyandtheHealthInsurancePortabilityandAccountabilityAct(HIPAA).

EachMTFhasadesignatedprivacyofficertoanswerquestionsyoumayhaveaboutyourpatientrightsandtoensurethathealthcareinformationremainsprivate,butavailabletoyouandyourprovider.KeepinmindthatifyouseecivilianTRICAREnetworkprovidersoutsideoftheMTF,theymayhavetheirownprivacypractices.Itisimportanttocarefullyreadanyinformationaboutprivacypractices.

Ifyouthinkyourprivacyrightshavebeenviolated,youmaysubmitawrittencomplainttoyourMTF,TRICAREManagementActivity(TMA)PrivacyOfficer,orregionalcontractor.

HIPAA and Privacy

In1996,CongressenactedHIPAAtocombatfraudandabuse,improveportabilityofhealthinsurancecoverage,andsimplifyhealthcareadministration.AllmilitaryandcivilianhealthcareplansandproviderswhoelectronicallyconductcertainfinancialandadministrativetransactionsmustcomplywithHIPAA.

TolearnmoreaboutyourprivacyrightsunderHIPAA,visitwww.tricare.mil/hipaa.QuestionsregardingHIPAAissuesmaybesenttoPrivacymail@tma.osd.mil.

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Release of Records and Personal Health Information

Uponrequest,yourproviderwillgiveyouacopyofyourmedicalrecords.Youmaybeaskedtogiveidentifyinginformation,suchasyourdateofbirth,SocialSecuritynumber,orphotoidentification,foryourprotection.

Ifyouwouldlikesomeoneelsetohaveacopyof,oraccessto,yourmedicalrecords,youwillneedtocompleteandsubmitaformauthorizinganypersonwhomyoudesignatetohaveaccesstoyourinformation.Theseformsvarybyregion.ContactyourregionalcontractororTRICAREAreaOffice(TAO)fordetails.

Yourauthorizationisrequiredforanyuseordisclosureofyourhealthinformation,exceptwhenrequiredtocarryouttreatment,payment,healthcareoperations,fitness-for-dutydeterminations,oranyothercircumstancesconsideredappropriateandnecessaryasoutlinedintheMilitary Health System Notice of Privacy PracticesandincompliancewithHIPAAprivacyandsecurityrules.TodownloadacopyoftheMilitary Health System Notice of Privacy Practices,visitwww.tricare.mil/mybenefit/home/Medical/RecordsAndPrivacy.

Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act of 1992

TheAlcohol,DrugAbuse,andMentalHealthAdministration(ADAMHA)ReorganizationActof1992placesspecificrequirementsuponfederalagenciesfortheconfidentialityanddisclosureofrecordscontainingtheidentity,diagnosis,prognosis,ortreatmentofanybeneficiaryinconnectionwithasubstanceabuse,alcoholism,oralcoholabuseprogram.

TRICAREcontractorsestablishandmaintainproceduresandcontrolsforthepurposeofassuringtheconfidentialityofbeneficiaryrecords.DisclosureofinformationcontainedwithincontractorrecordsisonlyprovidedinaccordancewithDepartmentofDefense(DoD)privacyregulations.

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For Information and Assistance

TRICARE in Your Region

TheTRICAREprogramismanagedinfourregions—threeU.S.regionsandoneoverseasregiondividedintothreeareas.

U.S. Regions

TRICAREregionalcontractorscanassistyouwithenrollment,referralandauthorizationguidelines,claimsprocessing,andcustomerservicedetails.Forstatesservedineachregion,visitwww.tricare.mil/mybenefit.Figure7.1onthefollowingpagelistsU.S.regionalcontractorcontactinformation.

Note:TRICAREbeneficiariesenrolledintheUSFamilyHealthPlan(USFHP)shouldfollowUSFHPguidelinesforaccessingcare.Call1-800-74-USFHP (1-800-748-7347)orvisitwww.usfamilyhealthplan.orgfordetails.

foR InfoRmATIon And AssIsTAnCE

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1. This service is available only to active duty service members (ADSMs) and active duty family members (ADFMs) enrolled in a TRICARE Prime option. Note: ADSMs must have a military treatment facility primary care manager referral or Military Medical Support Office service point of contact authorization before calling these lines.

U.S. Region Regional Contractor

TRICARE North Region

HealthNetFederalServices,LLC•BehavioralHealthCareProviderLocatorandAppointmentAssistanceLine:1-877-747-9579(8 a.m.–6 p.m. Eastern Time)1

•Generalinformation:1-877-TRICARE(1-877-874-2273)•TRICAREReserveSelect:1-800-555-2605•www.healthnetfederalservices.com

TRICARE South Region

HumanaMilitaryHealthcareServices,Inc.•BehavioralHealthCareProviderLocatorandAppointmentAssistanceLine:1-877-298-3514(8 a.m.–7 p.m. Eastern Time)1

•GeneralinformationandContinuedHealthCareBenefitProgram(CHCBP):1-800-444-5445•Activedutyprograms:1-877-249-9179•NationalGuardandReserve:1-877-298-3408•WarriorNavigationandAssistanceProgram:1-888-4GO-WNAP(1-888-446-9627)•www.humana-military.com

TRICARE West Region

TriWestHealthcareAllianceCorp.•BehavioralHealthCareProviderLocatorandAppointmentAssistanceLine:1-866-651-4970(8 a.m.–6 p.m. in all West region time zones)1

•BehavioralHealthContactCenter:1-888-TRIWEST(1-888-874-9378)•Generalinformation:1-888-TRIWEST(1-888-874-9378)•TriWestBehavioralHealthCrisisLine:1-866-284-3743•www.triwest.com

Figure 7.1TRICARE Regional Contractors

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Overseas Region

TheTRICAREoverseasregionisdividedintothreeareas:TRICAREEurasia-Africa,TRICARELatinAmericaandCanada(TLAC),andTRICAREPacific.

ExceptinPuertoRico,regionalcontractorsarenotavailabletoassistyouinoverseasareas.Instead,contactthelocalmilitarytreatmentfacility(MTF),TRICAREAreaOffice(TAO),orTRICAREGlobalRemoteOverseas(TGRO)AlarmCenter(if eligible)forassistance.InPuertoRico,contactthePuertoRicoCallCenter.SeeFigures7.2,7.3,and7.4forthesecontacts.


TRICARE Eurasia-Africa(Europe, Africa, and the Middle East)

TAO—Eurasia-Africa•Stateside:1-888-777-8343,option1•Commercial:011-49-6302-67-7433/7434•DSN:496-7433/7434•E-Mail:[email protected]•www.tricare.mil/eurasiaafrica

TRICARE Latin America and Canada(Central and South America, the Caribbean Basin, Canada, Puerto Rico, and the Virgin Islands)

TAO—TLAC•Stateside:1-888-777-8343,option3•Commercial:1-706-787-2424•DSN:773-2424•E-Mail:[email protected]•www.tricare.mil/tlac

TRICARE Pacific(Australia, Guam, Japan, Korea, New Zealand, and Western Pacific remote countries)

TAO—Pacific•Stateside:1-888-777-8343,option4•Commercial:011-81-6117-43-2036•DSN:643-2036•E-Mail:[email protected]•www.tricare.mil/pacific

Figure 7.2TRICARE Area Offices (TAOs)

www.tricare.mil

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Additional Resources and Contacts

Figures7.5and7.6listadditionalresourcestoassistyou.

Eurasia-Africa TGRO Alarm Center

•Commercial:011-44-20-8762-8133•E-Mail:[email protected]

TLAC TGRO Alarm Center

•Stateside:1-800-834-5514•E-Mail:[email protected]

Pacific TGRO Alarm Centers

Singapore •Commercial:011-65-6-338-9277•E-Mail:[email protected]

Sydney•Commercial:011-61-2-9273-2760•E-Mail:[email protected]

Figure 7.3TRICARE Global Remote Overseas (TGRO) Alarm Centers

Canadian Forces Health Facility Locator

•www.tricare.mil/tlac/canada_cfhf.cfm

Puerto Rico Call Center

•Stateside:1-800-700-7104

U.S. Naval Hospital, Guantanamo Bay

•Commercial:011-53-99-72110or011-53-99-72360

Figure 7.4Other Overseas Contacts

Army, Air Force, Navy, Marine Corps

•1-888-MHS-MMSO(1-888-647-6676)

Coast Guard •1-888-MHS-MMSO(1-888-647-6676)•1-800-9HBA-HBA(1-800-942-2422)

National Oceanic and Atmospheric Administration

•1-800-662-2267

U.S. Public Health Service

•1-800-368-2777,option2

Figure 7.5Military Medical Support Office Service Points of Contact

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Beneficiary Web Enrollment (BWE)

•https://www.dmdc.osd.mil/appj/bwe/

Defense Enrollment Eligibility Reporting System (DEERS)

•www.tricare.mil/deers

Guard and Reserve Web Portal

•https://www.dmdc.osd.mil/Guard-ReservePortal

Medicare •Stateside:1-800-633-4227•www.medicare.gov

Military Medical Support Office (MMSO)

•Stateside:1-888-MHS-MMSO(1-888-647-6676)•www.tricare.mil/mmso

MTF Locator •www.tricare.mil/mtf

Network Provider Locator

•www.tricare.mil/findaprovider

TRICARE Reserve Select Web Application

•https://www.dmdc.osd.mil/appj/trs

TRICARE Survivors Benefits Information

•www.tricare.mil/survivors

TRICARE Web Site •www.tricare.mil

U.S. Embassy or Consulate Locator

•www.usembassy.gov

US Family Health Plan (USFHP)

•Stateside:1-800-748-7347•www.usfamilyhealthplan.org

ValueOptions •Stateside:1-800-700-8646

Wisconsin Physicians Service (WPS)

•Stateside:1-866-773-0404•Stateside(TTY/TDD):1-866-773-0405•Overseas(Eurasia-Africa/Pacific):1-608-301-2310•Overseas(TLAC/Puerto Rico):1-608-301-2311•www.TRICARE4u.com

Figure 7.6Other Helpful Resources

www.tricare.mil

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Other Behavioral Health Resources

Defense and Veterans Brain Injury Center:CollaborateswiththeDepartmentofDefense,theDepartmentofVeteransAffairs,andcivilianpartnerstoserveactivedutyservicemembers(ADSMs)andveteranswithtraumaticbraininjury(TBI).Tolearnmore,visitwww.dvbic.org,call1-800-870-9244,[email protected].

Department of Veterans Affairs (VA):OffersenhancedenrollmentbenefitsandafullrangeofVAhealthcareservicestoeligibleveterans(including Operation Enduring Freedom and Operation Iraqi Freedom veterans)forfiveyearsafterdischargefromthemilitary.ContactyourregionalVAmedicalcenterforfurtherdetailsorvisitwww.va.gov.

Mental Health Self-Assessment Program:Providesfree,voluntary,andanonymousonlineandtelephoneself-assessments.Oncetheassessmentiscompleted,informationonwheretogoforafullevaluationisprovided.Alsoavailableistheeducationalvideo,A Different Kind of Courage: Safeguarding and Enhancing Your Psychological Health.Formoreinformation,visitwww.mentalhealthscreening.org/militaryorcall1-877-877-3647.

Military & Family Life Consultants (MFLCs): SupportADSMs,NationalGuardandReservemembers,andtheirfamiliesbyprovidingdirect,face-to-face,non-medicalcounselingandeducationregardingdailylifestressorsrelatedtodeploymentandreintegration.MFLCsaddressconcernsofstress,relationships,familyproblems,financialissues,griefandloss,conflictresolution,andtheemotionalchallengesoftransitioningfromcombatbacktocivilianlife.Formoreinformation,visitwww.mhngs.comorcall1-800-646-5613.

Military OneSource:Offersuptosix,cost-free,confidentialcounselingsessionstoeligiblemilitarypersonnelandtheirfamilymembers.Counselingisavailableinpersonorbyphoneandaddressesshort-termissues,suchasgriefandloss,deployment

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adjustment,work/lifemanagement,andcombatstress.Visitwww.militaryonesource.comorcall1-800-342-9647.

Note for ADSMs: ReceivingareferralfromaMilitaryOneSourceconsultanttoaMilitaryOneSourcecounselorisnotthesameasbeingreferredbyyourprimarycaremanager(PCM)orobtainingapprovalfromyourMMSOservicepointofcontact.NotifyyourPCMbeforeseekingcivilianbehavioralhealthcare.

Recommended Reading List

Books for Children

Love, Lizzie: Letters to a Military Mom • byLisaTuckerMcElroy

My Life—A kid’s journal • availableontheHealthNetWebsiteatwww.healthnetfederalservices.com

The Kissing Hand • byAudreyPenn

We Serve Too! A Child’s Deployment Book • byKathleenEdlick

When Dad’s at Sea • byMindyPelton

Deployment Materials

Help from Home • videosavailableontheTriWestWebsiteatwww.triwest.com.

Helping Children Cope During Deployment • byUniformedServicesUniversityoftheHealthSciences

Military Youth Coping with Separation: When Family Members •Deploy(forteens)andMr. Poe and Friends Discuss Reunion After Deployment(elementaryagechildren)bytheAmericanAcademyofPediatrics(AAP).ViewthevideosontheAAPMilitaryYouthDeploymentSupportWebsiteathttp://www.aap.org/sections/uniformedservices/ deployment/index.html.

Single Parenting While Your Partner Is Deployed • byCeridianCorporation

Support the Child Whose Military Parent Is Deploying: Tips for •ParentsbyDr.ThomasHardaway


www.tricare.mil

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Online Behavioral Health Resources

Air Force Crossroads: • Onlinecommunitynetworkofferingabroadrangeofinformationandservices.Visitwww.afcrossroads.com.

Deploymentkids.com: • Activitiesforkidsduringaparent’sdeployment.Visitwww.deploymentkids.com.

Military.com: • Offersinformationregardingdeployments,pay,benefits,andmore.Visitwww.military.com.

Military Child Education Coalition: • Informationforparents,teachers,andcounselors,plusresourcesthatprovidesupportforchildrenduringdeployment.Visitwww.militarychild.org.

National Guard Family Program: • Facilitateseducation,outreachservices,andpartnershipstoenhancequalityoflifeforNationalGuardmembersandtheirfamiliesandcommunities.Visitwww.guardfamily.org.

National Military Family Association: • Informationaboutdeploymentsandstress.ClickonDeployment and Youatwww.nmfa.org.

Operation Healthy Reunions: • Provideseducationandhelpscombatthestigmaofbehavioralhealthissuesamongservicemembers,theirfamilies,andmedicalstaff.Visitwww.nmha.org/reunions.

Our Survivors: • U.S.Armyresourceforsurvivorsofdeceasedservicemembersprovidingavarietyofbehavioralhealthresources.Alsooffersa“GuideforFamiliesofFallenSoldiers.”Visitwww.armyfamiliesonline.org.

Reserve Component Resource Center: • InformationabouttheresourcesavailabletohelpNationalGuardandReservefamilieswhilemembersareonactiveduty.Visitwww.pdhealth.mil/reservist/families.asp.

Sesame Workshop • ®: Bilingualmultimediaoutreachprogram,createdbySesameStreet®,designedtosupportmilitaryfamilieswithchildrenbetweentheagesof2and5affectedbydeployments.Visitwww.sesameworkshop.org/tlc.

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The Navy and Marine Corps Public Health Center: • HealthpromotionWebsitefeaturingasectioncalled“MindingYourMentalHealth™.”Visitwww.nmcphc.med.navy.mil/hp/mmh.

Tragedy Assistance Program (TAPS) for Survivors: • Offerspeersupportandassistancetosurvivorsofdeceasedmilitaryservicemembersthroughawidevarietyofprograms.Visitwww.taps.orgformoreinformation.

U.S. Army HOOAH for Health Web Site: • Includesanentiresectiondevotedtomaintainingahealthymind.Visitwww.hooah4health.com/mind.

Warriorcare.mil:• Arangeofonlineresourcestoassistservicemembersandtheirfamilies.Visitwww.warriorcare.mil.

Zero to Three • ®:Informationaboutthedeploymentcycleandwhattoexpect.Visitwww.zerotothree.org.


www.tricare.mil

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AcronymsADFM ActiveDutyFamilyMemberADHD AttentionDeficitHyperactivityDisorderADSM ActiveDutyServiceMemberBCAC BeneficiaryCounselingandAssistanceCoordinatorCHCBP ContinuedHealthCareBenefitProgramCMFT CertifiedMarriageandFamilyTherapistDCAO DebtCollectionAssistanceOfficerDEERS DefenseEnrollmentEligibilityReportingSystemDoD DepartmentofDefenseECT ElectroconvulsiveTherapyFY FiscalYearHIPAA HealthInsurancePortabilityandAccountability

Actof1996LOD LineofDutyMMSO MilitaryMedicalSupportOfficeMTF MilitaryTreatmentFacilityOHI OtherHealthInsurancePCM PrimaryCareManagerPHP PartialHospitalizationProgramPOS PointofServicePSA PrimeServiceAreaPTSD Post-TraumaticStressDisorderRTC ResidentialTreatmentCenterSPOC ServicePointofContactSUDRF SubstanceUseDisorderRehabilitationFacilityTAMP TransitionalAssistanceManagementProgramTAO TRICAREAreaOfficeTBI TraumaticBrainInjuryTFL TRICAREForLifeTGRO TRICAREGlobalRemoteOverseasTLAC TRICARELatinAmericaandCanadaTMA TRICAREManagementActivityTOP TRICAREOverseasProgramTPR TRICAREPrimeRemote

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TPRADFM TRICAREPrimeRemoteforActiveDutyFamilyMembers

TRIAP TRICAREAssistanceProgramTRS TRICAREReserveSelectTSC TRICAREServiceCenterU.S. UnitedStatesUSFHP USFamilyHealthPlanVA DepartmentofVeteransAffairsWPS WisconsinPhysiciansService

ACRonyms

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GlossaryAuthorization

Authorizationsmustbeobtainedpriortocertainservicesbeingrenderedorwithin24hoursofanemergencyadmission.Failuretoobtainanauthorizationwhenrequiredmayresultinadenialofpaymentforthoseservices.

Beneficiary

AbeneficiaryisapersonwhoiseligibleforTRICAREbenefits.Beneficiariesincludeactivedutyfamilymembers(ADFMs)andretiredservicemembersandtheirfamilies.Familymembersincludespousesandunmarriednaturalchildrenorstepchildrenuptotheageof21(or 23 if full-time students at accredited institutions of learning).Seewww.tricare.milforothereligiblebeneficiarycategories.

Continued Health Care Benefit Program (CHCBP)

Apremium-basedhealthcareprogramyoumaypurchaseafterthelossofTRICAREeligibilityifyouqualify.TheCHCBPofferstemporarytransitionalhealthcoverageandmustbepurchasedwithin60daysafterTRICAREeligibilityends.

Cost-Share

Acost-shareisthepercentageorportionofcoststhatthebeneficiarywillpayforinpatientoroutpatientcare.

Deductible

TheannualamountabeneficiarymustpayforcoveredoutpatientbenefitsbeforeTRICAREbeginstosharecosts.

Defense Enrollment Eligibility Reporting System (DEERS)

Adatabaseofuniformedservicesmembers(sponsors),familymembers,andothersworldwidewhoareentitledunderlawtomilitarybenefits,includingTRICARE.BeneficiariesarerequiredtokeepDEERSupdated.DEERSistheofficialsystemofrecordforTRICAREeligibility.Seewww.tricare.mil/deersformoreinformation.

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Designated Provider

UndertheUSFamilyHealthPlan(USFHP),designatedproviders(DPs),formerlyknownasuniformedservicestreatmentfacilities,areselectedcivilianmedicalfacilitiesaroundtheU.S.assignedtoprovidecaretoeligibleUSFHPbeneficiaries—includingthosewhoareage65andolder—wholivewithintheDParea.AttheseDPs,theUSFHPprovidesTRICAREPrimebenefitsandcost-sharesforeligiblepersonswhoenrollinUSFHP,includingthosewhoareMedicareeligible.

Enrollee

ATRICAREbeneficiarywhohaselectedtoenrollinaTRICAREprogramoption(e.g., TRICARE Prime, TRICARE Prime Remote, TRICARE Overseas Program Prime).

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

HIPAAwasintroducedtoimproveportabilityandcontinuityofhealthinsurancecoverageinthegroupandindividualmarkets;tocombatwaste,fraud,andabuseinhealthinsuranceandhealthcaredelivery;topromotetheuseofmedicalsavingsaccounts;toimproveaccesstolong-termcareservicesandcoverage;tosimplifytheadministrationofhealthinsurance;andforotherpurposessuchasprivacy.

Military Treatment Facility (MTF)

Amedicalfacilityoperatedbythemilitary(e.g., hospital, clinic).

National Guard and Reserve

TheNationalGuardandReserveincludestheArmyNationalGuard,theArmyReserve,theNavyReserve,theMarineCorpsReserve,theAirNationalGuard,theAirForceReserve,andtheCoastGuardReserve.

glossARy

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Network Provider

Anetworkproviderisaprofessionalorinstitutionalproviderwhohasacontractualrelationshipwiththeregionalcontractortoprovidecareatacontractedrate.AnetworkprovideragreestofileclaimsandhandleotherpaperworkforTRICAREbeneficiaries,andtypicallyadministerscaretoTRICAREPrimebeneficiariesandthoseTRICAREStandardbeneficiariesusingTRICAREExtra.AnetworkprovideracceptstherateTRICAREallows(TRICARE-allowable charge)aspaymentinfullforservicesrendered.

Non-Network Provider

Anon-networkproviderisonewhohasnocontractualrelationshipwiththeregionalcontractor,butisauthorizedtoprovidecaretoTRICAREbeneficiaries.Therearetwotypesofnon-networkproviders—participatingandnonparticipating.

Other Health Insurance (OHI)

Anynon-TRICAREhealthinsurancethatisnotconsideredasupplement.Thisinsuranceisacquiredthroughanemployer,entitlementprogram,orothersource.Underfederallaw,TRICAREisthesecondarypayertoallhealthbenefitsandinsuranceplans,exceptforMedicaid,TRICAREsupplements,theIndianHealthService,orotherprogramsorplansasidentifiedbytheTRICAREManagementActivity(TMA).

Point of Service Option

Thepointofservice(POS)optionallowsTRICAREPrimeenrolleestoreceivenonemergencycarefromanyTRICARE-authorizedproviderwithoutreceivingaprimarycaremanager(PCM)referral.ThePOSoptionhashigherout-of-pocketcostsandisnotavailabletoactivedutyservicemembers(ADSMs).

Primary Care Manager (PCM)

ATRICAREciviliannetworkproviderormilitarytreatmentfacility(MTF)providerwhoprovidesprimarycareservicestoTRICAREbeneficiaries.APCMiseitherselectedbythebeneficiaryorassignedbyanMTFcommanderorhisorherdesignatedappointee.TRICAREPrimeRemote(TPR)beneficiariesmaychooseaTRICARE-authorizedproviderifanetworkproviderisnotavailable.

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Prior Authorization

Areviewdeterminationmadebyalicensedprofessionalnurseorotherhealthcareprofessionalforrequestedservices,procedures,oradmissions.Authorizationsmustbeobtainedpriortocertainservicesbeingrenderedorwithin24hoursofanemergencyadmission.Failuretoobtainapriorauthorizationwhenrequiredmayresultinadenialofpaymentforthoseservices.

Referral

Theactorinstanceofreferringabeneficiarytoanotherauthorizedproviderfornecessarymedicalorbehavioralhealthcaretreatment.

Regional Contractor

See“TRICARERegionalContractors.”

Service Point of Contact

Theuniformedservicesofficeorindividualresponsibleforauthorizingcivilianhealthcareforactivedutyservicemembers(ADSMs)enrolledinTRICAREPrimeRemote(TPR).

Sponsor

Theactivedutyservicemember(ADSM)orretireethroughwhomfamilymembersareeligibleforTRICARE.

Transitional Assistance Management Program (TAMP)

Transitionalhealthcareforcertainuniformedservicesmembers(and eligible family members)whoseparatefromactiveduty.

TRICARE-Authorized Provider

AproviderwhomeetsTRICARE’slicensingandcertificationrequirementsandhasbeencertifiedbyTRICAREtoprovidecaretoTRICAREbeneficiaries.IfyouseeaproviderwhoisnotTRICARE-authorizedandcanneverbecertified,youareresponsibleforthefullcostofcare.TRICARE-authorizedprovidersincludedoctors,hospitals,ancillaryproviders(laboratories and radiology centers),andpharmacies.TherearetwotypesofTRICARE-authorizedproviders:networkandnon-network.

glossARy

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TRICARE Area Office (TAO)

TheseofficesarelocatedineachoverseasareatoassistyouwithTRICAREoverseasprograms.

TRICARE Regional Contractors

CivilianpartnerswhoprovidehealthcareservicesintheTRICAREregions(i.e., Health Net Federal Services, LLC; Humana Military Healthcare Services, Inc.; TriWest Healthcare Alliance Corp.).

US Family Health Plan (USFHP)

ProvidestheTRICAREPrimemanagedcareoptionthroughnetworksofcommunity-based,not-for-profithealthcaresystemsinsixareasoftheUnitedStates.USFHPisnotavailableoverseasandenrollmentisrequired.YoumustberegisteredintheDefenseEnrollmentEligibilityReportingSystem(DEERS)andresideinoneofthedesignatedUSFHPserviceareas.USFHPenrolleesarenoteligibleforcareatmilitarytreatmentfacilities(includes pharmacy services).

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List of TablesFigure 5.1U.S.TRICAREPrimeOptionADSMs:

OutpatientCare...........................................................35

Figure 5.2TOPPrimeandTGROADSMs:OutpatientCare...........................................................37

Figure 5.3U.S.TRICAREPrimeOptionADFMs:OutpatientCare...........................................................40

Figure 5.4TOPPrimeandTGROADFMs:OutpatientCare...........................................................42

Figure 5.5U.S.TRICAREStandardADFMs:OutpatientCare...........................................................44

Figure 5.6TOPStandardADFMs:OutpatientCare....................45

Figure 5.7CHCBPandTRSBeneficiaries:OutpatientCare...........................................................51

Figure 5.8U.S.TRICAREPrimeRetireesandFamilies:OutpatientCare...........................................................54

Figure 5.9U.S.TRICAREStandardRetireesandFamilies:OutpatientCare...........................................................56

Figure 5.10TOPStandardRetireesandFamilies:OutpatientCare...........................................................57

Figure 5.11U.S.TFLBeneficiaries:OutpatientCare....................60

Figure 5.12OverseasTFLBeneficiaries:OutpatientCare............62

Figure 7.1TRICARERegionalContractors................................66

Figure 7.2TRICAREAreaOffices(TAOs)................................67

Figure 7.3TRICAREGlobalRemoteOverseas(TGRO) AlarmCenters..............................................................68

Figure 7.4OtherOverseasContacts..............................................68

Figure 7.5MilitaryMedicalSupportOffice ServicePointsofContact..........................................68

Figure 7.6OtherHelpfulResources............................................69

lIsT of TAblEs

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IndexA

Activedutyfamilymember(ADFM),18–19,30–31,38–45,47,66,76

Activedutyservicemember(ADSM),16,18–20,24,30–32,34–37,47,66,70–71,78–79

Alcohol,DrugAbuse,andMentalHealthAdministrationReorganizationActof1992,64

Alcoholabuse,15,64Alcoholism,23,64Anorexianervosa,13Anxiety,6,11–14,38,52AttentionDeficitHyperactivityDisorder(ADHD),12Authorizations,5,16–20,24,31,33–37,39–45,49–51,53–62,64–66,76,79

Aversiontherapy,23

B

Behavioralhealthcareadmissions,34,36,40–41,43,45,50,53,55,57,59,61

Behavioralhealthcareservices,20,23–24,26,28,47,58BehavioralHealthCareProviderLocatorandAppointmentAssistanceLine,28,34,37,40,42,66

Bingeeatingdisorder,13Bioenergetictherapy,23Bulimianervosa,13

C

Carecoordination,39Certifiedmarriageandfamilytherapist,26Certifiedpsychiatricnursespecialists,26Clinic,19,35,37,77Clinicaldepression,12Collateralvisits,17Commandsponsorship,39Conjointpsychotherapy,17

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Consulate,29,43–45,49,51,53–57,59–60,62,69ContinuedHealthCareBenefitProgram(CHCBP),48–51,66,76Cost-share,19,25,43–44,55–56,58,76–77Counselors,18,26,40,42–43,45,50,54–55,57,60,62,71–72Currency,25

D

Deductible,19,25,58,76DefenseEnrollmentEligibilityReportingSystem(DEERS),69,76,80

Delayed-effective-orders,46DepartmentofVeteransAffairs(VA),4,48,52,70Deployment,6–11,13,18,32,38,70–73Depression,6,12–14,52Designatedproviders,77Detoxification,22Developmentaldisorders,24Disability,27,52,58Disulfiram,23Drugabuse,22,64

E

Eatingdisorders,13Electroshock,24Electrostimulationtherapy,24Eligibility,18–19,25,30–31,33,38–39,46–49,52,69,76,80Emergency,4–5,18,20,22,31,34–35,39,41,43–44,48–49,53,55–56,59,61,76,79

Environmentalecologicaltreatments,23Exclusions,16,23–24Experimentalprocedures,23Eyemovementdesensitizationandreprocessing(EMDR),23

F

Familytherapy,22–24,26Fitness-for-duty,33,64Fraud,63,77

IndEx

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84

G

Grouptherapy,23GuardandReserveWebPortal,47,69

H

HealthInsurancePortabilityandAccountabilityAct(HIPAA),63–64,77

HealthNetFederalServices,LLC(HealthNet),66,71,80Hostnationprovider,25,31,44–45,51,54,56–57,60HumanaMilitaryHealthcareServices,Inc.(HumanaMilitary),66,80

I

Inpatientadmissions,34,36,40–41,43–45,50,53,55,57,59,61Inpatientbehavioralhealthcare,20–22,34,36,40–41,43,45,50,53,55,57–59,61,76

Inpatientpsychotherapy,16Inpatientservices,20

L

Licensedclinicalsocialworkers,26Licensedorcertifiedmentalhealthcounselor,26,40,42–43,45,50,54–55,57,60,62

M

Marathontherapy,23Maritaltherapy,23,26Medicalnecessity,16–17,19–24Medicare,30,52,58–62,69,77Medicationmanagement,17–19,26Megavitamin,23MentalHealthSelf-AssessmentProgram,3,70Mildtraumaticbraininjury(TBI),13Military&FamilyLifeConsultants(MFLCs),70MilitaryHealthSystemNoticeofPrivacyPractices,64MilitaryMedicalSupportOffice(MMSO),16,28,34–35,66,68–69,71

85

MilitaryOneSource,70–71Militarytreatmentfacility(MTF),16,19–20,28,33–37,40–45,47–48,51,53–57,59–61,63,66–67,69,77–78,80

MTFcare,44–45,48,54,56–57

N

Narcotherapy,24NationalGuardandReserve,30–31,39,46,48–49,66,70,72,77NationalSuicidePreventionLifeline,4Networkproviders,19,40,42,49,54,63,69,78–79Nonemergencycare,20,24,33–34,36–37,40–43,45,50,53,55,57,59,61,78

Non-networkproviders,25,78–79Nonparticipatingproviders,60,62,78

O

Otherhealthinsurance(OHI),29,31,58–59,78Out-of-pocketcosts,78Outpatientbehavioralhealthcare,21–23,31,34–37,40,42–45,50–51,54–58,60,62,76

Outpatientpsychotherapy,16Outpatientservices,16,40,42–43,50,54–55,60Overseas,16,25,27–28,31,33–37,39–45,47–57,59–62,65,67–69,80

P

Partialhospitalization,21–22,44,57,59,61Participatingprovider,25,60,62,78Pastoralcounselors,26,40,42–43,45,50,54–55,57,60,62Physicianreferral,26,40,42–43,45,50,54–55,57,60,62Pointofservice(POS),24,39–40,42,53–54,78Post-traumaticstressdisorder(PTSD),3,13Pre-activationbenefits,46Primaltherapy,24Primarycaremanager(PCM),19,27–28,34–37,39–42,53–54,66,71,78

IndEx

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86

Primarypayer,30–31,58–62PrimeServiceArea,47Priorauthorization,17,19–20,24,31,33–37,39–45,49–51,53–62,66,76,79

Privacyofficers,63Psychiatrist,5,26Psychoanalysis,17Psychologicaltesting,17,26Psychologist,5,26Psychosurgery,24Psychotherapy,16–17,19,26PuertoRicoCallCenter,28,34–37,41–42,67–68

R

Regionalcontractor,16,18,20,26–28,39–40,43–44,48–50,53–56,59–60,63–67,78–80

Rehabilitation,21–22Residentialtreatmentcenter(RTC),21,24,44,57,59,61Retiredservicemember,30–31,52,76Retiree,3,19,53–58,79Retireefamilymember,52Rolfing,24

S

Schizophrenia,23Servicepointofcontact(SPOC),16,19,28,34–35,66,68,71,79Sexualproblems,12Sexualdysfunction,24Smokingcessation,24SocialSecuritynumber,64Sponsor,31,38–39,42,76,79Stress,6–7,10–11,13–14,18,23,38,52,70–72Substanceabuse,14,17,21,64Substanceusedisorder,14,21–22Suicide,4,13–15Survivors,31,69,72–73

87

T

TelementalHealthProgram,19–20Telephonecounseling,24TOPPrime,33,35–37,39,41–42,47,77TOPStandard,39,44–45,47,52,56–57Traininganalysis,24Transcendentalmeditation,24TransitionalAssistanceManagementProgram(TAMP),18,39,47–49,79

Traumaticbraininjury(TBI),13,70TRICARE-allowablecharge,25,78TRICARE-authorizedprovider,19,22,26,40,42,44–45,49,51,56–57,63,78–79

TRICAREAreaOffice(TAO),16,28,33,36,39–45,49–51,53–57,59–62,64,67,80

TRICAREAssistanceProgram(TRIAP),18TRICAREEurasia-Africa,44,56,61,67–69TRICAREExtra,19,39,43–44,47–48,52,55–56,78TRICAREForLife(TFL),25,58–62TRICAREGlobalRemoteOverseas(TGRO),16,27–28,33–37,39,41–42,67–68

TRICARELatinAmericaandCanada(TLAC),36–37,44,56,61,67–69

TRICAREManagementActivity(TMA),63,78TRICAREOverseasProgram(TOP),33,35–37,39,41–42,44–45,47,52,56–57,77

TRICAREPacific,44,56,61,67–69TRICAREPrime,19,24,30,32,34–35,38–40,47,52–54,66,77–78,80

TRICAREPrimeRemote(TPR),32,34,38,77–79TRICAREPrimeRemoteforActiveDutyFamilyMembers(TPRADFM),38

TRICAREregionalcontractors,16,18,20,26–28,39–40,43–44,48–50,53–56,59–60,63–67,78–80

TRICAREReserveSelect(TRS),18–19,48–51,66,69TRICAREReserveSelect(TRS)Webapplication,69

IndEx

88

TRICAREServiceCenter(TSC),16,27–28,31,33,37,39–40,42–45,49–51,53–57,59–62

TRICAREStandard,19,39,43–44,47–48,52,55–56,58,78TriWestBehavioralHealthCrisisLine,66TriWestHealthcareAllianceCorp.(TriWest),66,71,80

U

USFamilyHealthPlan(USFHP),28,30,63,65,69,77,80U.S.Embassy,29,43–45,49,51,53–57,59–60,62,69

V

ValueOptions,29,41–42,44,48,50,57,61,69VAhotline,4

W

WisconsinPhysiciansService(WPS),25,29,41,58,60–61,69

Z

Ztherapy,24

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www.tricare.mil

HA

131B

ET1

1090

Documents

A TRICARE Guide: Understanding Behavioral Healthnavybmr.com/study material/UNDERSTANDING BEHAVIORAL...A TRICARE Guide Understanding Behavioral Health Common Concerns, Helpful Resources,