Tricare Page: http://www.tricare.osd.mil/U.S. Department of Defense Military Health System
Tricare Page: http://www.tricare.osd.mil/
This website has extensive information on all aspects of military health care. I would recommend going to the "Site Map" to navigate your way through the site easier. Here are just a few things of interest to cleft lip/palate:
Of interest: In the "Provider's Handbook" Section See: Non-Covered Dental Services:
(Excerpt)
Non-Covered Dental Services
Preventive, routine, restorative, prosthodontic and emergency dental care
Adding or modifying bridge work and dentures
Orthodontics, except when directly related to correction of a cleft palate
Note: Pre-authorization is needed for adjunctive dental care. Providers should contact the appropriate contractor.
Note: The TRICARE Active-Duty Family Dental Plan is not part of the TRICARE medical benefits program. The Reserve Dental Plan and the Retiree Dental Plan are separate insurance programs administered by civilian contractors.
Note: Covered oral surgical procedures that are essentially medical rather than dental may not require pre-authorization. Contact your claims processing contractor to determine whether a planned oral surgery procedure requires preauthorization.
- Surgery to correct accidental injury
- Medically necessary surgery of accessory sinuses, salivary glands or ducts
- Excision of tumors and cysts of the jaws, cheeks, lips, tongue, roof and floor of the mouth when the condition requires a pathological exam
- External incision and drainage of cellulitis
- Fractures of facial bones
- Correction of cleft palate
- Oral and facial cancer
- Reduction of dislocations and the excision of the temporomandibular joints, when surgery is a necessary part of the reduction
- Surgical intervention necessitated by physician-induced trauma
Plastic or Reconstructive Surgery (excerpted from that page)
TRICARE Standard covers plastic, cosmetic and reconstructive surgery only in the following situations:
- Plastic surgery can be costshared when it is needed to restore function. For example, plastic surgery on a patient's nose would be covered if it was necessary for the patient to breathe. It would not be covered just to improve the person's looks. Because this can be a gray area, check with your HBA or the regional TRICARE contractor if you have questions, before getting care;
- Plastic surgery can be costshared for the following reasons:
- To correct a serious birth defect, such as a cleft lip;
TRICARE: What Is It?
TRICARE is the name of the Defense
Department's new regional managed health care program for service families.
Under TRICARE, you'll generally have three choices of ways in which to get your
health care:
Here's a brief look at each of the three options: TRICARE Prime
This is a voluntary health maintenance organization-type (HMO) option. If you
decide to get your health care through TRICARE Prime, you'll pay an annual
enrollment fee (except for active-duty families, who may enroll free) and enroll
for a year at a time. Normally, you'll receive your care from within the Prime
network of civilian and military providersSee. You'll either choose or be assigned a Primary Care Manager (PCM) from within
the contractor's network or at your nearest uniformed services medical facility,
who will furnish most of your care and will manage all aspects of your care,
including referrals to specialists. The Health Care Finder (HCF) assists in
finding the appropriate specialty care for you. Covered services will be like those of regular CHAMPUS (now known as TRICARE
Standard), plus additional preventive and primary care services that aren't
covered under TRICARE Standard or TRICARE Extra. For example, periodic health
promotion/disease prevention surveillance screenings (most people think of them
as routine physical exams) are covered at no charge under TRICARE Prime. Prime
also covers certain immunizations, as well as examinations for various cancers
and infectious and cardiovascular diseases, and other screenings, with certain
age and frequency limitations. Is TRICARE Prime the Right
Plan For You?
It depends. On the one hand, TRICARE Prime is the least costly of the three
TRICARE options. You'll be able to predict your health care costs more exactly.
As noted earlier, there's no enrollment fee for active-duty families-just modest
co-payments when you get health care within the Prime network of civilian
providers. Prime is easy to use. You'll have a Primary Care Manager (PCM) in the Prime
provider network, from whom you'll get most of your care, and who will refer you
to specialists within the network when necessary. Your local Health Care Finder
(HCF) at the TRICARE Service Center (TSC) will make the arrangements for you to
get the specialized care after you receive a referral from your PCM. The services of Health Care Finders are available to you 24 hours a day,
seven days a week. And the various TRICARE Service Centers in the region served
by your contractor will have representatives available during regular business
hours to provide a variety of information about all aspects of your health
benefits. There's less paperwork with Prime. When you get care from a provider who's
part of the Prime network, you don't have to file claims (but if you should seek
care from a non-network provider, you or the provider may have to file a claim
with the regional TRICARE contractor). On the other hand, TRICARE Prime may not be your best bet if you have other
health insurance that's your primary coverage. In such a case, Prime will only
pay after your other insurance has paid whatever it's going to pay
for your civilian care. Also, if you discontinue your other health
insurance when you enroll in Prime, and later become ineligible for Prime, you
might have difficulty getting your other insurance back. Or, if you travel out of your TRICARE Prime service area very often, Prime
might not be your best choice. The reason: When you get civilian care outside
your TRICARE Prime service area, Prime will only pay for emergency
services-unless the care you receive has been authorized in advance by the
Health Care Finder in your home service area. You might not want to enroll in TRICARE Prime if you don't want to be
restricted to using only providers who are members of the Prime network. A
better choice might be either the TRICARE Extra or TRICARE Standard (CHAMPUS)
options, which are described later in this chapter. When you enroll in TRICARE Prime, your enrollment is for one year at a time.
During the enrollment period, you're "locked in" to using only Prime
(with the expensive exception of getting care under the
"point-of-service" option-more about that later in this chapter)
unless you become ineligible for TRICARE during the enrollment period, or unless
you move from your local TRICARE Prime service area to a non-Prime area and have
to disenroll from Prime as a result. Note: There are no pre-existing condition limitations for enrollment in TRICARE
Prime or for use of the other two TRICARE health care options, Extra and
Standard. TRICARE Extra
In this option, you don't have to enroll or pay an annual fee. You do have to
satisfy an annual deductible for outpatient care, just as you do under TRICARE
Standard. (See the section on TRICARE Standard below, and also see the chapter
titled "How Much Will It Cost?" for more information about the
deductible under TRICARE Standard.) The deductible and cost-sharing works the
same way under TRICARE Extra. On a visit-by-visit basis, you can seek care from a provider who's part of
the TRICARE Extra network, get a discount on services, and have reduced
cost-shares-five percent less than under TRICARE Standard. Also, you generally
won't have to file any claim forms. You pay annual deductibles for outpatient
care before government cost-sharing starts, as you do under TRICARE Standard.
You can get a list of the TRICARE Extra providers by contacting one of the
TRICARE service centers located in your region, or by calling the toll-free
number established by the TRICARE contractor. TRICARE Standard
This option is the regular CHAMPUS program with a new name. It pays a share
of the cost of covered health care services that you obtain from an authorized
non-network civilian health care provider. There's no enrollment in TRICARE
Standard. You'll pay the normal TRICARE Standard deductibles for outpatient
care, and your cost-sharing percentages will be the same as for regular CHAMPUS.
If you have questions about your military health care benefits under TRICARE, there are many places to get answers. Each medical facility has a Health Benefits Advisor, Managed-Care Office or TRICARE Service Center. This should be your first contact for information. Additionally, below are telephone numbers for each region, where you can call and get information about TRICARE and your health care benefits.
Check here for additional REGIONAL information
Region 1
Maine, New Hampshire, Vermont, Massachusetts, Connecticut, Rhode Island,
Delaware, Maryland, New Jersey, New York, Pennsylvania, the District of
Columbia, northern Virginia, and the northeast corner of West Virginia
Expected operational mid 1998
1-202-782-1486
Region 2
North Carolina and most of Virginia
Expected operational mid 1998
1-800-990-8272
Region 3
South Carolina, Georgia, and Florida excluding panhandle
Operational July 1, 1996
1-800-444-5445
Region 4
Florida panhandle, Alabama, Mississippi, Tennessee and eastern third of
Louisiana
Operational July 1, 1996
1-800-444-5445
Region 5
Michigan, Wisconsin, Illinois, Indiana, Ohio, Kentucky, and West Virginia
excluding the northeast corner
Expected operational mid 1998
1-513-255-9690
Region 6
Oklahoma, Arkansas, western two thirds of Lousiana, Texas, excluding southwest
corner
Operational November 1, 1995
1-800-406-2832
Region 7/8
New Mexico, Arizona excluding Yuma, Nevada and southwest corner of Texas,
including El Paso, Colorado, Utah, Wyoming, Montana, Idaho excluding northern
Idaho, North Dakota, South Dakota, Nebraska, Kansas, Minnesota, Iowa and
Missouri
Operational April 1997
1-888-TRIWEST (874-9378)
Region 9
Southern California and Yuma, Arizona
Operational April 1, 1996
1-800-242-6788
Region 10
Northern California
Operational April 1, 1996
1-800-242-6788
Region 11
Washington, Oregon, and northern Idaho
Operational March 1, 1995
1-800-404-0110
Region 12
Hawaii
Operational April 1, 1996
1-800-242-6788
Europe
Europe, Africa, Middle East, Azores, Iceland
Operational October 1996
011-49-6371-47-6230/6387
Pacific
Alaska, Hawaii, WESTPAC
Expected operational October 1997
1-808-433-6846
Latin America
Panama, Central America, South America
Expected Operational Late 1997
011-507-284-6977
More Websites:
Websites for Specific Military Bases
(Note: Click here for a more detailed listing of Uniformed Services Medical Facilities)
The Air Force Surgeon General's Advanced Desktop: http://usafsg.satx.disa.mil/
AFMSA - Air Force Medical Support Agency: http://usafsg.satx.disa.mil:90/master.html
Air Force Behavioral Science Corner: http://members.aol.com/AFBSC/index.html
Information and Resources for Air Force Mental Health ProfessionalsUSAF School of Aerospace Medicine: http://wwwsam.brooks.af.mil/
Andersen AFB, Guam. General Medical Info: http://www.andersen.af.mil/med.htm
Andrews AFB, Maryland. 89th Medical Group: http://www.aon.af.mil/89med/89thmed.htm
Altus AFB, Oklahoma. 97th Medical Group: http://www.lts.aetc.af.mil/pgmdg.html
Barksdale AFB, Louisiana. 2nd Medical Group: http://131.10.254.80/2wg/2mdss/
Beale AFB, California. 9th Medical Group: http://www.beale.af.mil/9mdg/index.htm
Bolling AFB, Washington DC. 11th Medical Group: http://www.bolling.af.mil/medical/11mdg.htm
Cannon AFB, New Mexico. 27th Medical Group: http://www.cannon.af.mil/mdg/
Edwards AFB, California. 95th Medical Support Group: http://medwww.elan.af.mil/MDSS/mdss.html
Elmendorf AFB, AK. 3rd Medical Group: http://yukla-27.topcover.af.mil/medgp/welcome.htm
McGuire AFB, Ft Dix, New Jersey. 305th Medical Group: http://www.mcguire.af.mil/medgp/
Onizuka Air Station, California. 750th Medical Squadron: http://saint.oafb.af.mil/750MDS/750tha.htm
Patrick AFB, Florida. 45th Medical Group: http://www.pafb.af.mil/45MDG/45mdg.htm
Travis AFB, California. 60th Medical Group: http://usafsg.satx.disa.mil/~dgmc/
Wright-Patterson AFB, Ohio. 74th Medical Group: http://wpmc1.wpafb.af.mil/
Army Surgeon General: http://www.medcom.amedd.army.mil/otsg/
(USACHPPM) Medical Safety And Health Program 56:
http://chppm-www.apgea.army.mil/Armyih/Pgms/hlth-haz.htmU. S. Army Center For Health Promotion & Preventive Medicine, Aberdeen Proving Ground, Maryland (USACHPPM) http://chppm-www.apgea.army.mil/
US Army Dental Corps: http://www.dencom.army.mil/
121st General Hospital, Korea: http://204.208.30.45/18sub121.htm
94th General Hospital, Dallas, TX: http://www.cs.amedd.army.mil/94thgh/index.html
Tripler Army Medical Center, Honolulu, Hawaii: http://www.tamc.amedd.army.mil/index.htm
Walter Reed Army Medical Center, Washington D.C: http://www.wramc.amedd.army.mil/
161 ASMB Alabama Army National Guard http://halyard.iar.net/~smithart
Navy Surgeon General: http://support1.med.navy.mil/bumed/sg.htm
Fleet Hospital Support Office, Alameda, California http://www.fhso.navy.mil/
Naval Hospital Corps School http://support1.med.navy.mil/nhcsgl/
Naval Health Research Center (NHRC) - Supports fleet operational readiness through RDT&E on the biomedical and psychological aspects of Navy and Marine Corps personnel health and performance. http://mac088.nhrc.navy.mil/
Neural Human-System Interface (NHSI) Development - We are developing real-time objective alertness monitoring using EEG and eye-tracking technology. http://128.49.52.9/
Naval Hospital, Oak Harbor, Washington http://192.108.8.100/index.htm
Naval Hospital, Bremerton, Washington http://nh_bremerton.med.navy.mil/
Naval Hospital, Camp Lejeune, North Carolina http://lej-www.med.navy.mil/
Naval Hospital, Corpus Christi, Texas http://192.101.131.150/
Naval Hospital, Jacksonville, Florida http://199.208.118.32/
Naval Hospital, Pensacola, Florida http://pcnh-srv.medweb.navy.mil/
Naval Hospital, Camp Pendelton http://206.39.123.73/nhcp/nhcp.htm
Naval Hospital, Cherry Point, NC http://cpoint-www.med.navy.mil/
Naval Hospital, Millington TN http://192.101.123.40/
Naval Hospital, Twenty-Nine Palms, California http://www.nhtp.med.navy.mil
Naval Hospital, Lemoore, California http://nmimc-web1.med.navy.mil/lemoore/
Naval Medical Center, San Diego http://159.71.170.20/index.html
Naval Medical Center, Portsmouth, Virginia http://www-nmcp.med.navy.mil/
Naval Medical Clinic, Annapolis, Maryland http://nmclanna.nadn.navy.mil/
Naval Medical Clinic, Quantico, Virginia http://nmimc-web1.med.navy.mil/nmclquan/
Naval Medical Logistics Command http://www-nmlc.med.navy.mil/
Naval School of Health Sciences (NSHS) - Bethesda http://www-nshs.med.navy.mil/
U.S. Naval Hospital, Keflavik (Iceland) http://northstar.med.navy.mil/
Naval School of Health Sciences - San Diego http://support1.med.navy.mil/nshssd/
Naval HealthCare Support Office, San Diego, California http://support1.med.navy.mil/hsosd/
Naval HealthCare Support Office, Jacksonville, Florida http://199.10.155.3/
Navy Pharmacy http://support1.med.navy.mil/NAVYPHAR/
Naval Dental Centers
Naval Dental Research Institute; Great Lakes, Illinois http://nmimc-web1.med.navy.mil/NDRI/
More Naval Dental Centers http://support1.med.navy.mil/med-06/med06-1.htm#g
Also of interest:
http://support1.med.navy.mil/bumed/med.htm
http://support1.med.navy.mil/bumed/links.htm
Miscellaneous Military Links
Search through these sites for additional information (Medical and more)
These page created by Kat Huck. If the links above don't work, or if you have links to add to this page, please email me. Thanks!