Health and Wellness

Guide to Military Healthcare: A Comprehensive Guide for New Service Members and Their Families

Table of Contents

  1. Introduction
  2. Understanding Military Healthcare
  3. Introduction to TRICARE
  4. Medical Benefits and Coverage
  5. Accessing Healthcare Services
  6. Differences in Coverage
  7. Mental Health Services
  8. Fertility Services
  9. Exceptional Family Member Program (EFMP)
  10. Service-Connected Disability
  11. Reporting an Injury and Maintaining Deployment Readiness
  12. Limited Duty and Medical Board Process
  13. Fraudulent Enlistment
  14. Medical Leave in the Military
  15. List of Military Treatment Facilities Worldwide
  16. Conclusion

 

 

Introduction

Welcome to the world of military healthcare. As a new service member, understanding your healthcare options is crucial for your well-being and that of your family. This guide aims to provide you with comprehensive information about TRICARE, medical and dental plans, mental health services, fertility services, immunization requirements, service-connected disabilities, and more. By the end of this eBook, you will have a clear understanding of the healthcare benefits available to you and how to make the most of them.

 

Understanding Military Healthcare

Overview of Military Healthcare

Military healthcare is designed to provide comprehensive medical support to service members and their families. The system includes medical facilities on military bases, civilian healthcare providers, and specialized programs like TRICARE.

Key Components of Military Healthcare

  • Military Treatment Facilities (MTFs): These are hospitals and clinics located on military bases that provide a wide range of medical services to active-duty members and their families.
  • Civilian Healthcare Providers: Through TRICARE, service members and their families can access healthcare services from civilian providers who are part of the TRICARE network.
  • TRICARE: This is the healthcare program serving uniformed service members, retirees, and their families. TRICARE offers various plans tailored to different needs and situations.

 

Introduction to TRICARE

What is TRICARE?

TRICARE is a healthcare program for military personnel and their families, providing access to healthcare services through both military and civilian healthcare providers. TRICARE offers several plans to cater to the diverse needs of service members.

TRICARE Plans Overview

TRICARE Prime

  • Eligibility: Active-duty service members and their families, retirees and their families, and certain other eligible individuals.
  • Features: Managed care option that provides comprehensive coverage, including primary care, specialty care, hospitalization, and preventive services. Requires enrollment and assignment to a Primary Care Manager (PCM).

TRICARE Prime Remote

  • Eligibility: Active-duty service members and their families who live and work more than 50 miles or approximately one hour's drive time from a Military Treatment Facility.
  • Features: Similar to TRICARE Prime but designed for service members and families stationed in remote locations. Provides comprehensive coverage with no out-of-pocket costs when using TRICARE network providers and services.

TRICARE Select

  • Eligibility: Active-duty family members, retirees and their families, and certain other eligible individuals.
  • Features: Fee-for-service plan that offers flexibility in choosing healthcare providers. Does not require enrollment with a PCM but includes deductibles and cost-shares.

TRICARE For Life

  • Eligibility: Retirees and their families who are eligible for Medicare.
  • Features: Secondary coverage to Medicare, covering costs that Medicare does not, such as copayments and deductibles.

TRICARE Reserve Select

  • Eligibility: Selected Reserve members and their families.
  • Features: Premium-based plan similar to TRICARE Select, offering comprehensive coverage including preventive care, emergency care, and hospitalization.

TRICARE Retired Reserve

  • Eligibility: Retired Reserve members and their families who are not yet eligible for TRICARE For Life.
  • Features: Premium-based plan similar to TRICARE Select, providing a wide range of healthcare services.

TRICARE Young Adult

  • Eligibility: Young adult dependents of eligible sponsors who are under 26 years old.
  • Features: Offers TRICARE Prime or TRICARE Select coverage at a premium.

TRICARE Dental Program

  • Eligibility: Active-duty family members, Selected Reserve and Individual Ready Reserve members and their families.
  • Features: Comprehensive dental coverage including preventive, diagnostic, and emergency dental services.

 

Medical Benefits and Coverage

Medical Services Covered

  • Primary Care: Routine check-ups, screenings, and preventive services.
  • Specialty Care: Referrals to specialists for specific medical conditions.
  • Emergency Care: Services provided in emergency situations.
  • Hospitalization: Inpatient care for illnesses, surgeries, and other medical conditions.
  • Maternity and Newborn Care: Comprehensive coverage for prenatal, delivery, and postnatal care.
  • Mental Health Services: Access to counseling, therapy, and psychiatric services.
  • Fertility Services: Coverage for certain fertility treatments and counseling.
  • Exceptional Family Member Program (EFMP): Support for family members with special needs.
  • Transgender Healthcare: Coverage for medically necessary services related to gender dysphoria and transition.
  • Plastic Surgery: Limited coverage, typically for reconstructive purposes rather than cosmetic enhancements.

Coverage for Service Members vs. Family Members

Service members and their families have access to different types of care and coverage options under TRICARE:

  • Service Members: Receive comprehensive healthcare coverage at no cost when using Military Treatment Facilities or TRICARE network providers. This includes all necessary medical, dental, mental health, and emergency services.
  • Family Members: Coverage is also extensive but may involve some cost-shares, deductibles, and copayments depending on the plan chosen (e.g., TRICARE Prime or TRICARE Select).

Requirements for Family Member Coverage

To be covered as a beneficiary under TRICARE, family members must meet certain criteria:

  1. Eligibility: Family members must be enrolled in the Defense Enrollment Eligibility Reporting System (DEERS). Eligible family members include:
    • Spouses
    • Biological and adopted children
    • Stepchildren (if they live with the sponsor)
    • Legal wards
    • Children under legal guardianship
  2. Enrollment: Family members must be enrolled in a TRICARE plan. Enrollment can be done online through the Beneficiary Web Enrollment website or by completing the necessary forms and submitting them to the appropriate TRICARE contractor.
  3. Documentation: Required documents for enrollment include marriage certificates for spouses and birth certificates or adoption papers for children.
  4. Maintenance: It is important to keep DEERS records up to date to avoid any disruption in coverage.

Pharmacy Benefits

TRICARE provides a robust pharmacy benefit, allowing access to prescription medications through Military Treatment Facility pharmacies, TRICARE Pharmacy Home Delivery, and network pharmacies.

Filling Prescriptions

  1. Military Treatment Facility Pharmacy: You can fill your prescriptions at a pharmacy located at a Military Treatment Facility at no cost.
  2. TRICARE Pharmacy Home Delivery: Prescriptions can be delivered to your home. This is particularly useful for long-term medications.
  3. Network Pharmacies: You can fill your prescriptions at TRICARE network pharmacies. There may be a copayment for this service.
  4. Non-Network Pharmacies: You can use non-network pharmacies, but this will likely result in higher out-of-pocket costs.

Urinalysis and Prescription Medications

When you are on prescription medications, it is important to disclose this information during routine urinalysis tests to avoid any misunderstandings regarding drug use.

  1. Documentation: Always have documentation of your prescription available.
  2. Disclosure: Inform the medical personnel conducting the urinalysis of your prescriptions.
  3. Verification: The prescription information can be verified through the Military Treatment Facility or your PCM.

 

Accessing Healthcare Services

Finding a Provider

TRICARE beneficiaries can find network providers through the TRICARE website or by contacting their regional contractor. It is essential to choose a provider within the TRICARE network to minimize out-of-pocket costs.

Making Appointments

Appointments can be made directly with healthcare providers. For specialty care, a referral from the Primary Care Manager may be required. Emergency care does not require a referral, but it is recommended to inform the PCM as soon as possible.

Understanding Costs

While TRICARE covers many healthcare services, there may still be costs such as copayments, cost-shares, and deductibles. Understanding your specific TRICARE plan's cost structure is essential to managing healthcare expenses effectively.

Primary Care Manager (PCM)

A Primary Care Manager (PCM) is a healthcare provider assigned to TRICARE Prime beneficiaries. The PCM serves as the first point of contact for all healthcare needs, providing routine care, coordinating referrals to specialists, and managing overall healthcare.

How to Use Your PCM

  1. Enrollment: When you enroll in TRICARE Prime, you will be assigned a PCM, typically located at a Military Treatment Facility (MTF).
  2. Primary Contact: Always contact your PCM first for any medical issue, unless it is an emergency.
  3. Referrals: Your PCM will provide referrals to specialists if necessary. You must get a referral from your PCM to see a specialist or for certain services.
  4. Coordinated Care: Your PCM coordinates your care, ensuring all aspects of your health are managed effectively.

The Referral Process

  1. Consult Your PCM: For any non-emergency health concern that requires specialist attention, you must first see your PCM.
  2. Referral Authorization: Your PCM will refer you to a specialist and obtain authorization from TRICARE.
  3. Specialist Appointment: Once you have the referral authorization, you can schedule an appointment with the specialist.
  4. Follow-Up: After seeing the specialist, follow up with your PCM for continued care and any further treatment plans.

Consequences of Not Getting a Referral

If you see a specialist or receive certain services without a referral from your PCM, you may face:

  • Higher Out-of-Pocket Costs: TRICARE may not cover the costs, leaving you responsible for the entire bill.
  • Claim Denial: TRICARE may deny the claim entirely, and you will be responsible for paying for the service out-of-pocket.
  • Interrupted Care: Lack of coordination between your PCM and specialist may result in fragmented and less effective healthcare.

 

Differences in Coverage

Active-Duty Coverage

Active-duty service members receive comprehensive healthcare coverage, including all necessary medical, dental, and mental health services at no cost when using Military Treatment Facilities or TRICARE network providers.

Coverage for Reservists

Reservists not on active duty have access to TRICARE Reserve Select, a premium-based plan similar to TRICARE Select, offering comprehensive coverage including preventive care, emergency care, and hospitalization.

Coverage for Reservists on Active Duty

When called to active duty for more than 30 days, reservists receive the same comprehensive healthcare coverage as active-duty service members, including access to Military Treatment Facilities and TRICARE network providers.

 

Mental Health Services

Overview

TRICARE provides extensive mental health services to support the well-being of service members and their families. Services include:

  • Counseling: Individual, family, and group therapy.
  • Psychiatric Services: Diagnosis and treatment of mental health conditions.
  • Substance Use Disorder Treatment: Programs for detoxification, rehabilitation, and counseling.
  • Emergency Mental Health Care: Immediate support for acute mental health crises.

Accessing Mental Health Services

Mental health services can be accessed through Military Treatment Facilities, TRICARE network providers, or via referral from your Primary Care Manager.

 

Fertility Services

Overview

TRICARE covers certain fertility treatments and counseling services for eligible service members and their families. This includes:

  • Diagnosis and Treatment: Services to identify and treat fertility issues.
  • Counseling: Support and guidance for individuals and couples facing fertility challenges.

Accessing Fertility Services

Fertility services can be accessed through Military Treatment Facilities and TRICARE network providers. Coverage details and eligibility requirements may vary, so it is essential to consult with your healthcare provider.

 

Exceptional Family Member Program (EFMP)

Overview

The EFMP is designed to support service members who have family members with special needs. The program ensures that the necessary medical and educational services are available to support these families.

Services Provided

  • Medical Support: Access to specialized healthcare services.
  • Educational Support: Assistance with school accommodations and special education services.
  • Family Support: Resources and support groups for families with special needs members.

Enrolling in EFMP

Enrollment in the EFMP is mandatory for service members with family members who have special needs. The process includes a medical evaluation and submission of the required documentation to your installation's EFMP office.

 

Service-Connected Disability

What is a Service-Connected Disability?

A service-connected disability is a medical condition that was incurred or aggravated during active military service. The U.S. Department of Veterans Affairs (VA) provides disability compensation to veterans who have service-connected disabilities.

Disability Compensation

Disability compensation is a monthly tax-free benefit paid to veterans who have disabilities that are the result of a disease or injury incurred or aggravated during active military service. The amount of compensation depends on the severity of the disability and the veteran’s service record.

Factors Affecting Disability Compensation

  • Severity of Disability: The VA assigns a disability rating from 0% to 100% based on the severity of the condition.
  • Service Record: The length of service and circumstances under which the disability occurred can affect the compensation amount.
  • Dependents: Additional compensation may be available for veterans with dependents.

How to Apply for VA Disability Compensation

  1. Gather Documentation: Collect medical records, service records, and other evidence supporting your claim.
  2. Complete Application: Fill out VA Form 21-526EZ, "Application for Disability Compensation and Related Compensation Benefits."
  3. Submit Claim: Submit the application and supporting documents to the VA online through VA.gov, by mail, or with the help of a Veterans Service Officer (VSO).
  4. VA Review: The VA will review your claim and schedule any necessary medical examinations.
  5. Decision: You will receive a decision letter from the VA detailing the outcome of your claim and your disability rating.

 

Reporting an Injury and Maintaining Deployment Readiness

Reporting an Injury

Prompt reporting of injuries is crucial for receiving timely medical care and ensuring that the injury is documented for potential disability claims.

  1. Immediate Medical Attention: Seek immediate medical care for any injury, regardless of severity.
  2. Documentation: Ensure the injury is documented in your medical records by the healthcare provider.
  3. Command Notification: Notify your chain of command about the injury as soon as possible.
  4. Follow-Up Care: Attend all follow-up appointments and comply with prescribed treatment plans.

Maintaining Deployment Readiness

Maintaining deployment readiness involves staying physically fit and ensuring all medical and administrative requirements are up to date.

  1. Regular Check-Ups: Attend regular medical and dental check-ups.
  2. Immunizations: Keep all required immunizations current.
  3. Fitness: Maintain physical fitness standards as required by your branch of service.
  4. Medical Conditions: Report any changes in medical conditions to your PCM or healthcare provider.
  5. Readiness Status: Ensure your readiness status is updated in your service branch's medical readiness tracking system.

 

Limited Duty and Medical Board Process

Types of Limited Duty

Limited duty status is assigned to service members who have medical conditions that temporarily or permanently restrict their ability to perform their full duties. Types of limited duty include:

  1. Temporary Limited Duty (TLD): Assigned to service members expected to recover and return to full duty. Typically lasts no longer than six months but can be extended if necessary.
  2. Permanent Limited Duty (PLD): Assigned to service members with medical conditions that are not expected to improve, limiting their ability to perform certain duties permanently.

Medical Board Process

The Medical Board process evaluates service members who have medical conditions that may affect their ability to perform their duties. The process determines whether a service member can continue serving or if they should be separated or retired due to their medical condition.

Steps in the Medical Board Process

  1. Referral to Medical Board: A service member is referred to the Medical Evaluation Board (MEB) by their PCM or healthcare provider if they have a medical condition that may affect their duty performance.
  2. Medical Evaluation Board (MEB): The MEB reviews the service member's medical records, conducts examinations, and determines whether the condition is medically unfitting for continued service.
  3. Informal Physical Evaluation Board (IPEB): If the MEB finds the condition medically unfitting, the case is referred to the IPEB, which reviews the findings and makes a recommendation on fitness for duty.
  4. Formal Physical Evaluation Board (FPEB): If the service member disagrees with the IPEB's findings, they can request a formal hearing before the FPEB.
  5. Final Decision: The FPEB makes a final decision on the service member's fitness for duty, which can include retention, separation, or medical retirement.
  6. Appeal: Service members have the right to appeal the FPEB's decision if they believe it was unjust or inaccurate.

Consequences of the Medical Board Process

  • Retention: The service member is found fit for duty and returns to their unit.
  • Separation: The service member is separated from the military due to their medical condition.
  • Medical Retirement: The service member is retired with medical benefits if the condition is severe enough to warrant retirement.

 

Fraudulent Enlistment

Definition and Risks

Fraudulent enlistment occurs when an individual deliberately conceals or misrepresents information during the enlistment process, such as medical conditions, to enter the military. This includes failing to disclose pre-existing medical conditions at the Military Entrance Processing Station (MEPS).

Consequences of Fraudulent Enlistment

  1. Administrative Discharge: Individuals found to have fraudulently enlisted may be administratively discharged from the military. This type of discharge may carry consequences that affect future employment and veteran benefits.
  2. Punitive Actions: Depending on the severity of the concealment and the impact on military readiness, punitive actions such as fines or imprisonment could be enforced under the Uniform Code of Military Justice (UCMJ).
  3. Loss of Benefits: Veterans' benefits, including healthcare and disability compensation, may be forfeited if fraudulent enlistment is discovered.
  4. Reputation Damage: Fraudulent enlistment can damage the individual's reputation and credibility, both within and outside the military community.

Importance of Full Disclosure

It is crucial for potential enlistees to fully disclose all medical conditions and other relevant information during the enlistment process. Accurate information ensures that the individual receives appropriate care, and that the military maintains its readiness and capability.

 

Medical Leave in the Military

Sick Leave

Sick leave is granted to service members who are temporarily unable to perform their duties due to illness or minor injury. This leave allows them to recover without being charged against their regular leave balance.

  • Process: Service members must seek medical evaluation at a Military Treatment Facility or from their PCM. If the healthcare provider determines that the service member cannot perform their duties, they will issue a sick leave authorization.
  • Duration: The duration of sick leave is determined by the healthcare provider based on the nature and severity of the illness or injury.
  • Documentation: Proper documentation from the healthcare provider is required to validate the sick leave.

Convalescent Leave

Convalescent leave is a non-chargeable leave granted to service members recovering from a serious illness, injury, or surgery. This leave is recommended by a healthcare provider to allow for recovery without impacting the service member's leave balance.

  • Eligibility: Service members recovering from surgery, severe illness, or injury may be granted convalescent leave.
  • Approval: The healthcare provider recommends the leave, and it must be approved by the service member's commanding officer.
  • Duration: The length of convalescent leave varies based on the recovery needs and recommendations of the healthcare provider.

Mental Health Leave

Mental health leave is granted to service members who require time off to address mental health issues. This leave ensures they receive the necessary care and support without impacting their regular leave balance.

  • Process: Service members must seek evaluation from a mental health professional, either through a Military Treatment Facility or a TRICARE network provider. If the mental health provider determines that leave is necessary, they will issue a recommendation.
  • Duration: The duration of mental health leave depends on the individual's needs and the treatment plan recommended by the mental health provider.
  • Documentation: Proper documentation from the mental health provider is required to validate the leave.

 

List of Military Treatment Facilities Worldwide

United States

East Region:

  • Walter Reed National Military Medical Center - Bethesda, MD
  • Fort Belvoir Community Hospital - Fort Belvoir, VA
  • Womack Army Medical Center - Fort Bragg, NC
  • Naval Medical Center Portsmouth - Portsmouth, VA

West Region:

  • Madigan Army Medical Center - Joint Base Lewis-McChord, WA
  • Naval Medical Center San Diego - San Diego, CA
  • David Grant USAF Medical Center - Travis AFB, CA
  • Tripler Army Medical Center - Honolulu, HI

Europe

  • Landstuhl Regional Medical Center - Landstuhl, Germany
  • U.S. Naval Hospital Naples - Naples, Italy
  • U.S. Army Health Center Vicenza - Vicenza, Italy
  • RAF Lakenheath Medical Treatment Facility - Lakenheath, UK

Asia

  • U.S. Naval Hospital Yokosuka - Yokosuka, Japan
  • Brian D. Allgood Army Community Hospital - Camp Humphreys, South Korea
  • U.S. Naval Hospital Guam - Agana Heights, Guam
  • 121st Combat Support Hospital - Yongsan, South Korea

Middle East

  • U.S. Naval Hospital Bahrain - Manama, Bahrain
  • Eskan Village Clinic - Riyadh, Saudi Arabia
  • Al Udeid Clinic - Al Udeid Air Base, Qatar

Other Locations

  • U.S. Naval Hospital Okinawa - Okinawa, Japan
  • U.S. Naval Hospital Rota - Rota, Spain
  • Soto Cano Medical Element - Honduras
  • Thule Air Base Clinic - Thule, Greenland

 

Conclusion

Navigating military healthcare can be complex, but understanding your options and the resources available can help you make informed decisions for yourself and your family. TRICARE offers comprehensive medical and dental coverage tailored to the unique needs of service members. Stay informed, utilize available resources, and take proactive steps to ensure the health and well-being of your family.

For more information, visit the TRICARE website or contact your regional contractor. Welcome to the military community and thank you for your service.