TRICARE Health Benefits Advisors

Naval Medical Center Portsmouth

(757) 953-2610/2611

Michael Wilson, Andrew Argent

Little Creek TRIAD

• Boone Branch Health Clinic
  (757) 953-8351/8182
• Northwest Branch Health Clinic
  (757) 953-6250/6294
• Chesapeake TRICARE Prime Clinic
  (757) 953-6366/6382      

Sheila Green, Quenna Nash, Melinda King

Naval Station Norfolk TETRAD

• Naval Station Norfolk Branch Health Clinic
  (757) 953-9000/8708
• Norfolk Naval Shipyard Branch Health Clinic
  (757) 953-6500
• Suffolk TRICARE Prime Clinic
  (757) 953-7000/4927
• Yorktown Branch Health Clinic
  (757) 953-8445/8441

Brenda Baxendale, Mark Wise

Oceana TRIAD

• Oceana Branch Health Clinic
  (757) 953-3733/3881
• Dam Neck Annex
  (757) 953-9850-3922
• Virginia Beach TRICARE Prime Clinic
  (757) 953-6708/6710

Charles Thompson, Angela Butler, Teresa Carr, Cardette Fleming, Phyllis Cross

633rd Medical Group – Joint Base Langley-Eustis
(757) 225-5111

Kym Tran, Ashley Jenkins

McDonald Army Health Center-Ft Eustis
(757) 314-7500/7766/7748

Constance Long, JoAnne Pope

TRICARE Prime

https://www.tricare.mil/Plans/HealthPlans/Prime

TRICARE Prime is a health care option for Service Members (SMs), retirees, family members, and certain others. It is similar to a manage-care or health maintenance organization (HMO).

Primary Care Manager (PCM) will be assigned to beneficiaries by the Regional Contractor. Your access to specialty care is managed by your PCM and will be referred based on availability and capability.

Service Members are assigned to clinics that align to the unit they serve based within the Tidewater Market.

Uniformed Service Family Health Plan (USFHP)
 
The Uniformed Service Family Health Plan (USFHP) is a contracted TRICARE program which provides a “TRICARE Prime” like benefit for eligible military beneficiaries. In the Tidewater Market, the USFHP is facilitated through and contracted with Johns Hopkins Medicine. Beneficiaries may enroll into the USFHP if they reside in an eligible residential zip code within southeastern Virginia, including York, Poquoson, Newport News, Norfolk and Hampton, VA. Interested and eligible beneficiaries may enroll into the USFHP/Johns Hopkins via phone or through their established website. Beneficiaries will maintain the same out-of-pocket costs adherent to the TRICARE Prime program. Beneficiaries enrolled into the USFHP will receive all aspects of their care (to include primary/specialty care and pharmacy/laboratory services) through the Johns Hopkins network.
Beneficiaries enrolled into the USFHP maintain eligibility access to Military Treatment Facilities/Direct care system which is restricted/limited to emergency care services.      
 
https://www.usfhp.com/
https://www.hopkinsusfhp.org/
 

TRICARE Select

https://www.tricare.mil/Plans/HealthPlans/TS

TRICARE Select is for TRICARE-eligible beneficiaries who aren’t able to, or chose not to, enroll in a TRICARE Prime option. This program lets you manage your own health care and get care from any TRICARE-authorized provider without a referral.

TRICARE For Life

https://www.tricare.mil/Plans/HealthPlans/TFL

If you’re entitled to Medicare Part A, you generally must have Medicare Part B to keep TRICARE, regardless of your age or where you live. This is a requirement based on federal law with an exception for Service Members and their family. If you’re eligible for TRICARE and have Medicare Part A and Part B, you’re automatically covered by TFL.

Upon turning 65 years old and/or becoming Medicare eligible, if you were enrolled in TRICARE Prime and assigned to a PCM at the Military Treatment Facility (MTF); you will be automatically disenrolled from your PCM the day before you become Medicare Eligible.
 

TRICARE Plus

TRICARE Plus, a primary care access program, has limited enrollment capacity.  TRICARE Plus is not a comprehensive health plan but is an option under the TRICARE for Life program that allows beneficiaries to receive primary care at NMCP as long as there is capacity available. Enrollment availability and capacity varies by clinic or hospital, so enrollment is not transferrable from another hospital.

This affects those patients who are turning 65 years old, whether they are switching from TRICARE Prime, TRICARE Select, or are going into TRICARE for Life. Those TRICARE Plus patients that are already part of the TRICARE Plus program here at NMCP will remain. We will not disenroll any of our already established TRICARE Plus patients. 

The TRICARE Plus migration will only affect primary care services. Beneficiaries can continue to access NMCP’s ancillary services.

Direct Care

If you are not enrolled in a plan, you will have “Direct Care Only”. Direct Care is care received at an MTF on a space available basis only. Until you are enrolled in a plan, you will not be eligible for any civilian care to include using a Retail Network Pharmacy or Express Scripts Home Delivery.

You can only change TRICARE enrollment following a Qualifying Life Event (QLE) or during TRICARE Open Season.

https://www.tricare.mil/LifeEvents/QLE

Transition Assistance Management Program (TAMP)

- This program allows you and your dependents 180 days of premium free TRICARE coverage.

- Once DD214 is received, present documentation to PSD/DEERS/ID Card Lab to see if you qualify. TAMP determination is a Personnel function, not a TRICARE one.  If you qualify, contact the Regional Contractor within 90 days to enroll. Effective date should be backdated to date of separation.

- If DD214 coding does not qualify you for TAMP, TRICARE coverage for you and any dependents you may have will end midnight of your final day of active-duty service.

National Guard/Reserve Members and Families

- Please visit to following website to determine your benefits and how to enroll.

https://tricare.mil/RESERVE

Other TRICARE Programs

https://www.tricare.mil/Plans/HealthPlans

Prime Remote, Prime Overseas, Prime Overseas Remote, Select Overseas, Reserve Select, Retired Reserve, Young Adult Prime, Young Adult Select, US Family Health Plan.

1.    Call: (800) 444-5445

2.    Online: https://milconnect.dmdc.osd.mil/milconnect/

3.    Mail: DD Form 2876 to Regional Contractor

https://www.tricare.mil/GettingCare/FindDoctor/ChangePCM

https://www.tricare.mil/GettingCare/FindDoctor  

You can only change TRICARE enrollment following a Qualifying Life Event (QLE) or during TRICARE Open Season.

Open Enrollment Season is traditionally held during the last two weeks of November through the first two weeks of December. Exact dates are determined/published in October of each year. Changes/adjustments to plans during the Open Enrollment Season take effect January 1^st of the upcoming year.

You have three options to enroll or change enrollment:

1.    Call: (800) 444-5445

2.    Online: https://milconnect.dmdc.osd.mil/milconnect/

3.    Mail: DD Form 2876 to Regional Contractor

https://www.tricare.mil/enroll

https://www.tricare.mil/LifeEvents

https://www.tricare.mil/LifeEvents/Baby/GettingTRICAREforChild

1.    Register in DEERS within 90 days.

2.    Contact Regional Contractor to enroll in TRICARE Program.

3.    Contact NMCP Health Benefits Office (HBO) to register in MHS Genesis.

Marriage

https://www.tricare.mil/LifeEvents/Marriage

1.    Register in DEERS within 90 days.

2.    Contact Regional Contractor to enroll in TRICARE Program.

3.    Contact NMCP Health Benefits Office (HBO) to register in MHS Genesis.

Divorce

https://www.tricare.mil/Plans/Eligibility/FormerSpouses

• 20-20-20 = You are eligible for TRICARE as your own sponsor under your own Social Security Number

All 20 years of marriage overlap the 20 years of creditable (Active or Reserve) service which counted towards your sponsor's retirement.

• 20-20-15 = You're TRICARE eligible for one year from the date of the divorce/annulment.

15 of those years overlap the 20 years of creditable (Active or Reserve) service which counted towards your sponsor's retirement.

Survivors

https://www.tricare.mil/Plans/Eligibility/Survivors

TRICARE will keep covering family members when a sponsor dies. Spouses can keep their coverage until they remarry.

Transferring

IN LOCAL AREA

• You will remain assigned to your current PCM until you check into your new command.
• Active-Duty Family Members (ADFM) enrollments are not affected when transferring locally.

OUT OF LOCAL AREA

• You will remain assigned to your current PCM until you check into your new command.

ADFM enrollments will need to be updated by contacting the Regional Contractor.

As a Service Member, you are authorized to seek medical care at a MTF only, if one is available. If not, call the Nurse Advise Line (NAL) and go where you are directed. Urgent Care for Service Members is not authorized. ADFMs, however may receive care from an Urgent Care facility.

If there is an immediate threat to life, limb or eyesight; you are authorized to seek care from the nearest Emergency Room (ER). Following an ER visit, please schedule a follow up with your PCM to ensure your ER visit is properly authorized and that medical documentation is transferred back to the MTF.

Upon arrival at new command, contact Regional Contractor to be assigned to new PCM at your new Duty Station.
 

Appellate Leave

 ADSMs undergoing appellate leave in the Tidewater Market remain eligible for TRICARE benefits as delineated by DHA Procedural Instruction DHA-PI 6010.01 and DHA-PI 6000.12, which govern healthcare benefits for active-duty service members, including those on appellate leave. TRICARE coverage for ADSMs on appellate leave ensures both service members and their dependents have access to Military Treatment Facilities (MTFs) and/or Branch Health Clinics (BHCs). This encompasses primary care, specialty care, preventive care, and emergency services. To initiate medical care while executing appellate leave,
ADSMs must promptly report to the nearest MTF’s Health Benefits Office to confirm their TRICARE eligibility and facilitate TRICARE Prime enrollment into a designated MTF Primary Care Manager (PCM). While TRICARE offers extensive coverage, it is crucial to note its boundaries. ADSMs, to include those in an appellate leave status, are required to utilize TRICARE network providers. Certain services, including cosmetic interventions and treatments deemed non-essential, are not covered by TRICARE.
 
As you access health care in an appellate leave status, please be mindful and adhere to the following guidelines: 

• Routine Care - All routine care shall be facilitated through your assigned PCM.

• Acute Care - Acute care should be obtained through your assigned PCM if possible. All ADSMs should follow up with their PCM after any urgent care visit. ADSMs may also contact the Nurse Advise line (1-800-874-2273) for care recommendations and information.

• Emergency/Urgent Care - Emergent/emergency care should be obtained through NMCP Emergency Department (ED) if possible. ADSMs are also authorized to seek care from the nearest Hospital based Emergency Room or contact 911 as applicable for the initial evaluation of any emergency condition. ADSMs are required to immediately follow up with their assigned PCM upon hospital discharge. When traveling or located outside the Tidewater Market, ADSMs should proceed to the nearest Hospital Emergency Department for emergency/urgent care or acute care. ADSMs may also utilize the Nurse Advise line (1-800-874-2273) for acute care concerns if outside the Tidewater Market.

 Adherence to these guidelines during routine, acute, or emergency/urgent care is strongly recommended to avoid any unforeseen expenses.
Except in cases of emergency/urgent care at a hospitalbased Emergency Department, all received care from civilian sources/medical providers must be authorized in writing prior to obtaining care.

Separating

Service Members will remain assigned and enrolled with the current PCM through the end of terminal leave.

            - If leaving the area, go to the nearest MTF for care, if one is available. If not, call the Nurse Advise Line (NAL) and go where you are directed.

Retiring

Service Members will remain assigned and enrolled with the current PCM through the end of terminal leave.

            - If leaving the area, go to the nearest MTF for care, if one is available. If not, call the Nurse Advise Line (NAL) and go where you are directed. Service Members must have an authorization for all civilian care, even during terminal leave.

Obtain your retiree DoD ID Card as near to retirement date as possible.

            - You may schedule  an appointment at PSD/DEERS/ID Card by going to https://idco.dmdc.osd.mil/idco/.

Decide which TRICARE Retirement Program to enroll into.

            - TRICARE Prime or TRICARE Select

            - You MUST contact the Regional Contractor within 90 days of your retirement to enroll. If you don’t, you and your family will enroll in Direct Care (no civilian coverage).

            - Review FEDVIP plans, for dental and vision coverage. Contact BENEFEDS to enroll.

https://www.benefeds.com/

The sooner TRICARE gets your claim and supporting documentation, the sooner you or your provider will be paid. TRICARE claims processors process most claims within 30 days.

https://www.tricare.mil/FormsClaims

Check with your claim’s processor for more information.

Please contact NMCP Health Benefits Office (HBO) for assistance.

(757) 953-2610/2611