Tricare Overseas Program Update 13

Posted: March 17, 2012 in Uncategorized

If you are an overseas-based uniformed service retiree, you enjoy much more flexibility in choosing providers than TRICARE Overseas Program (TOP) Prime enrollees, since you don’t have a primary care manager and don’t need specialty care referrals. That’s your advantage when using TOP Standard. Many overseas host nation providers require up-front payment for services, and you usually have to file your own claims when using TOP Standard. Contact your TRICARE Overseas Program Regional Call Center at to get help in finding a host nation network provider or filing a TRICARE claim. You can also find a provider by using the overseas online TRICARE Provider Directory at
If you live in the Philippines, you must get care from a TOP-certified provider. You may find a certified provider from the Philippines Certified Provider Directory at or by going to and using the profile on the home page. Referrals are not needed for TOP Standard, but you must get prior authorization for some services. Always contact your TOP Regional Call Center and select option 3 to check on any new prior authorization requirements: Currently, prior authorizations are required for:
 Adjunctive dental services
 Home health services (only available in U.S. Territories)
 Hospice care (only available in U.S. Territories)
 Nonemergency inpatient admissions for substance use disorders or behavioral health care
 Outpatient behavioral health care visits beyond the eighth visit per fiscal year (Oct. 1–Sept. 30)
 Transplants – all organ and stem cell
If you become Medicare-eligible, be aware that TRICARE For Life acts the same as Standard overseas except in U.S. Territories. Although Medicare services are only available in U.S. Territories overseas, you must still enroll in Medicare Part B and pay the monthly Part B premium to be eligible for TRICARE For Life, regardless of location. You may sign up for Medicare at the Federal Benefits Office located at U.S. Embassies. In U.S. territories, go to your local Social Security Administration office. Enroll no later than two months before you turn 65, or if you qualify for Medicare due to end-stage renal disease, disability or Lou Gehrig’s disease, purchase Part B as soon as it is offered. Once you receive your Medicare card, verify that your record in the Defense Enrollment Eligibility Reporting System (DEERS) was updated to reflect your Medicare status. Uniformed services retirees cannot enroll in TOP Prime. At some overseas military treatment facilities, retirees can enroll in TRICARE Plus to obtain no-cost, space-available primary care in the facility. TRICARE Plus enrollees must make their own appointments, file their own claims and pay appropriate deductibles and cost-shares, however, when seeking host-nation care. For more information regarding TOP Standard and TRICARE For Life in overseas areas, visit [Source: TRICARE Management Activity Chris Hober article 22 Feb 2012 ++]


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