Understanding MTF priority for care

Understanding MTF priority for care

.
LRMC Public Affairs | .
published: March 03, 2017

Living overseas can present a set of challenges when it comes to medical care. Most servicemembers and dependents are enrolled in TRICARE and seen at military treatments facilities (MTFs).  Access to MTFs is based on government policy and needs of the current defense mission. To help regulate access and reduce confusion, the DOD has established a priority list for access to care.

PRIORITY 1: Active-duty servicemembers

Servicemembers enroll with an MTF and are assigned a primary care manager at a primary care clinic. If the type of service needed is not available, TRICARE Service Center (TSC) staff can help locate the same level of care at another MTF or through host-nation providers, and will assist with appointments and referral authorizations. There is no cost to servicemembers if they have a referral and prior authorization from the managed care support contractor, International SOS.

PRIORITY 2: Active-duty family members enrolled in TRICARE Prime

As with servicemembers, if health care is not available at the MTF, they will be referred to host-nation providers. TSC staff can help with making appointments with host-nation providers and provide copies of authorizations for care outside the MTF. There is no cost with referrals and prior authorization.

PRIORITY 3: Retirees and their family members enrolled in TRICARE Plus

This program is for direct care and is available at overseas MTFs on a case-by-case basis. An MTF’s participation in the TRICARE Plus program is determined by the MTF commander. Beneficiaries must enroll, and they are only eligible for care at the MTF where they are enrolled. When service is not available, TSC staff can provide host-nation provider lists to the beneficiary and assist with making appointments. If an MTF does not offer specialty care, TRICARE Plus enrollees may need to seek care from host-nation providers. A cost share and deductible will apply. In Germany, host-nation providers may require up-front payment before care is given.

PRIORITY 4: Active-duty family members who are TRICARE Standard (not enrolled in TRICARE Prime)

Care is received on a space-available basis, and cost share and deductibles may apply based on the sponsor’s rank.

PRIORITY 5: All other TRICARE-eligible persons

This applies to retirees, their family members and survivors who are not enrolled in TRICARE Plus or TRICARE Standard; they will receive care on a space-available basis.

PRIORITY 6: U.S. civilian personnel who are not TRICARE eligible (e.g. GS/NAF federal employees, AAFES and DODEA civilian employees, contractors assigned to Europe)

Civilian employees are seen at an MTF only on a space-available basis with the exception of emergency medical care and on a fully reimbursable basis.

Tags: MTF, health care, priority, Tricare
Related Content: Host nation health care