Historically health care for military personnel and their dependents was provided in military medical facilities on a “space-available” basis. To address the growing demand on the system, Congress passed the Dependents Medical Care Act of 1956 and the Military Medical Benefits Amendments of 1966, which allowed the Department of Defense to contract with civilian health care providers to provide care to military personnel. This health care program became known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS).
In the late 1980s, because of escalating costs, paperwork, and beneficiary dissatisfaction, the Department of Defense initiated a series of demonstration projects. One of these demonstration projects was the CHAMPUS Reform Initiative (CRI), in which a contractor with the Department of Defense provided both health care and administrative-related services, including claims processing. The CRI project was one of the first to introduce managed care features to the CHAMPUS program. In 1993, the Department of Defense extended and improved the CRI, and renamed it TRICARE.
WHO ADMINISTERS THE PROGRAM
On October 1, 2013, the Department of Defense established the Defense Health Agency (DHA) to manage the activities of the military health system. These activities include those previously managed by TRICARE Management Activity (TMA), which was disestablished on the same date. Regional contractors administer the TRICARE program in 3 regions within the U.S.: the TRICARE North Region, the TRICARE West Region, and the TRICARE South Region.
Health Net Federal Services, Inc. is responsible for administering the TRICARE program in the Northeast, which includes New York State.
TRICARE is federally funded through appropriations from Congress.
Summary of TRICARE
TRICARE is the health care program for active duty members and retirees of the seven U.S. uniformed services, as well as the reserve component, their family members, survivors and others who are listed in the Defense Enrollment Eligibility Reporting System. TRICARE beneficiaries are automatically renewed upon the expiration of the enrollment period unless the enrollee declines renewal, is no longer eligible or fails to pay an enrollment fee on a timely basis.
TRICARE offers several different health plan options. Availability of these options depends on whether the beneficiary is an active service member, a retiree, or a dependent/survivor.
The information contained in this chapter does not cover the many complexities that exist in obtaining TRICARE. There may be exceptions to eligibility that are not listed in this chapter. Therefore it is advisable to find additional information if a beneficiary does not meet the criteria listed below.