Voluntary disenrollment: You may voluntarily disenroll from TRICARE Prime. However, eligible beneficiaries not enrolled in a TRICARE plan are only covered for care at the military hospital or clinic under direct care if space is available. Beneficiaries can only re-enroll during the open enrollment season and/or in the event of a QLE.
Older members of the military, veterans and military retirees may be eligible for TRICARE, which is the health care program of the United States Department of Defense’s Military Health System. Americans who are over 65 years old or who have a qualifying disability are eligible for Medicare, the federal health insurance program. Telemedicine copayment waiver: TRICARE is waiving copayments and cost-shares for covered audio-only or audio/video telemedicine rendered by network providers on or after May 12, 2020. This waiver applies to covered in-network telehealth services, not just services related to COVID-19.
You may disenroll by:
- Beneficiary Web Enrollment (BWE)
- Mailing or faxing a TRICARE Prime Enrollment, Disenrollment and PCM Change Form.
- Telephone at 1-844-866-WEST (9378), Monday through Friday, 5:00 a.m.–9:00 p.m. (PT).
If voluntarily disenrolling, you can request a specific disenrollment date. Otherwise, the disenrollment will be effective the day after your paid-through date.
Non-payment: If HNFS does not receive your premium payment within 30 days from the due date, you will be disenrolled for failure to pay. Your disenrollment will be effective the day following your policy paid-through date. Once disenrolled from TRICARE Prime, you will be only eligible for coverage at the military hospital/clinic under direct care if space is available. Claims for services after your disenrollment date will not be paid under your TRICARE Prime coverage.
- Deductibles must be met before TRICARE benefits are payable. Once the deductible is met, cost-shares apply. Network providers can collect at a minimum the copayment at the time of service. A provider may also collect the outstanding balance of the deductible.
- PURPOSE: To allow you to view and manage you and your family's appointments at military hospitals and clinics, refill prescriptions, and view your personal health data through TRICARE Online. ROUTINE USES: Your records may be disclosed to the Department of Veterans Affairs for determining benefits and providing care, as well as to certain other.
Reinstatement
Tricare Retired Copays
If you are disenrolled from TRICARE Prime for failure to pay, you have 90 days from your disenrollment date to be reinstated. A full payment is required to bring the policy current.
- Visit our Make a Payment tool to determine your payment amount, bring your policy current and set up future automatic payments.
- After 90 days, you must wait until the next TRICARE Open Season or for a qualifying life event to occur to re-enroll.
Note: Visit our Copayment and Cost-Share Information page for 2020 costs.
View the cost information below for TRICARE Retired Reserve (TRR) beneficiaries.
- The sponsor's enlistment date does not determine costs.
- TRR members are covered under TRICARE Select. Benefits, cost-shares and deductibles are the same as Group B retirees.
| Enrollment Fees | $484.83/individual, $1,165.01/family (monthly) |
|---|---|
| Annual Deductibles | Network Providers: $153/individual, $317/family Non-Network Providers: $317/individual, $634/family |
| Catastrophic Cap | $3,703 per calendar year |
TRICARE Retired Reserve reminders:
- Beneficiaries may be required to pay up to 15% above the TRICARE allowed amount when using a nonparticipating provider.
- Annual deductibles apply to outpatient services only.
| Type of Care | Copayment/Cost-Share |
|---|---|
| Ambulance - Outpatient | Network: $63 Non-Network: 25% |
| Ambulance - Inpatient | Network: 25% Non-Network: 25% |
| Ambulatory Surgery | Network: $100 Non-Network: 25% |
| Ancillary Services | Network: $0 Non-Network: 25% |
| Durable Medical Equipment | Network: 20% Non-Network: 25% |
| Emergency Room | Network: $84 Non-Network: 25% |
| Home Health Care | $0* |
| Hospice Care | $0 |
| Hospitalization (includes mental health) | Network: $185 per admission Non-Network: 25% of allowable charges |
| Laboratory and X-Rays | Network: $0 Non-Network: 25% |
| Maternity Care - Inpatient Delivery Setting | Network: $179 per admission Non-Network: 25% of allowable charges |
| Office Visits - Primary Care | Network: $26 Non-Network: 25% |
| Office Visits - Specialty Care | Network: $42 Non-Network: 25% |
| Outpatient Mental Health Visits | Network: $42 Non-Network: 25% |
| Partial Hospitalization | Network: $42** Non-Network: 25% |
| Preventive Services - Eye Examinations | Not a covered benefit |
| Preventive Services - All Other Covered Services | $0 |
| Residential Treatment Center | Network: $52 per day Non-Network: Lesser of $317 per day or 20% of allowable charges |
| Skilled Nursing Facility | Network: $52 per day Non-Network: Lesser of $317 per day or 20% or allowable charges |
| Urgent Care Services | Network: $42 Non-Network: 25% |
Retired Tricare Prime Copays
*Costs may apply for durable medical equipment (DME) and medications/drugs.
**Copayment information is calculated per day for partial hospitalization programs and intensive outpatient treatment. Opioid treatment program services copayment is applied on a weekly basis.