This blog is the most recent in a series helping members of the Coast Guard family understand how to use their TRICARE benefits. The blog series will continue every Monday, right here on Coast Guard All Hands.
Written by Cmdr. Paul Fawcett
Because of the nature of our Service, Coast Guard members and their families are often stationed in remote locations. Remote locations often mean that you aren’t stationed near a military treatment facility; it may also mean that health care resources in your area may not be as available as they are in more populated regions. If those things are true, you’re likely covered by the TRICARE Prime Remote plan.
Unlike other TRICARE plans, you can’t select the TRICARE Prime Remote (TPR) option; you can only enroll if you are eligible. The eligibility requirements for TPR are that the sponsor’s home and work address are more than 50 miles, or one hour drive time, from a military treatment facility. This is a legal requirement and is not subject to waiver. You can check to see if you are eligible for TPR by entering your sponsors home and work zip codes into the TPR search engine on the TRICARE website.
It’s also important to note that eligibility for TPR is based on the sponsor, not family. If the military member voluntarily geographically separates from their dependants for an assignment, TRICARE plan eligibility will be based on the member, not the family. The exception is when a member deploys outside the US (OCONUS) on a tour to which dependents are not authorized. In that case TRICARE coverage for the family is based on the location at which they choose to reside.
TRICARE Prime Remote is designed to maximize the availability of health care resources available to you in small markets. TPR widens your options by allowing you to select from Primary Care Managers who are TRICARE authorized, but not in the TRICARE network. This gives you a greater selection of available physicians. TPR does not require enrollment fees or any copays for any treatment. You will need to have a TRICARE authorized referral for specialty care, if you don’t have one you may be billed for that care.
Family members have the option if they wish to enroll in TRICARE Standard; however, in most cases the cost/benefit analysis would favor TPR. The decision is up to the individual.
If you have an exceptionally family member that may require special medical services, and have, or may have, orders to a remote location, you should work with your work life staff, Command, and Assignment Officer. TPR areas may not have ready access to certain specialties such as autism therapy or mental/behavioral health services. Proper enrollment in the special needs program will allow the assignment process to determine if your family needs can be reasonably met in a remote location.
Q: I think I’m eligible for TPR. How do I enroll?
A: Visit the Web Beneficiary Enrollment Site and update your enrollment.
Q: My family and I live near a Coast Guard Clinic in a remote area. What coverage do we get?
A: Normally the member would be seen at the Coast Guard Clinic and would be considered TRICARE Prime. A survey of all clinics across the CG is being conducted now to determine if there are areas where families should be authorized TPR.
Q: I have questions about my eligibility, who should I call?
A: You should first call your TRICARE regional contractor:
– North Region: 1-877-874-2273
– South Region: 1-800-444-5445
– West Region: 1-877-988-9378
If you have problems or concerns, you can call the CG Health Benefits Assistance line at 1-800-9-HBA-HBA or email us at CGHBA@uscg.mil.