session long project

Posted: August 29th, 2013





Session Long Project






Session Long Project

TRICARE is a health care program under the United States Department of Defense Military Health System. It was previously known as the Civilian Health Program of the Uniformed Services. It was formed to provide civilian health services to the military Personnel and their dependents. The program is managed by the TRICARE Management Activity with authority from the Office of the Assistant Secretary of Defense. After the World War 2, there were major constraints in terms of the resources available at the Military health facilities. These inadequacies prompted the United States Congress to enact a legislation that allows the Secretary for Defense to contract private health care providers to provide their services to the military personnel. TRICARE health program is divided into several unique options; they include TRICARE Standard, TRICARE Extra, TRICARE Prime, TRICARE Reserve Select, TRICARE Reserve Retired, and TRICARE for Life and TRICARE Young Adult and others (Humana 2011).

TRICARE Standard is the basic option that is usually available to active duty personnel, retirees from the active component of the armed forces and retirees from the  Reserve component who are 60 years or older and their dependents if they are eligible to access the services. It is however, not available to active service personnel. TRICARE standard enables the beneficiary to have access to medical services using any civilian health care provider in the country. This program is provided for by the government. The beneficiary only contributes to cost sharing, deductibles and an allowable charge. The beneficiary accesses health services on a pay to access service basis. The plan allows the beneficiary to access any medical facility and specialized care without prior approval from a primary care manager. The beneficiary contributes to medical costs by paying 25% of the allowable charges and all other related institutional costs that were not included as per the TRICARE agreement. Non-network providers may charge 15% above the TRICARE allowable charges (Humana 2011).

However, TRICARE beneficiaries have limitations in regards from whom they seek treatment.Treatment can be from non-network providers and network providers. Network providers are in contract with the TRICARE Management Authority to provide healthcare. In addition, non-network providers offer healthcare at additional costs because they are not registered to file for claims in regards to the services offered. However, TRICARE services do not cover certain conditions such as psychiatric treatment for sexual dysfunction, obesity, cosmetic disfiguration, physical therapy and others. In the event that an individual loses his coverage, a certificate of creditable coverage is issued to him individually, and the rest of his dependents to show that they were previously covered with TRICARE.

The certificate serves the purpose of being in the records so as not to be excluded from new plans in relation to pre-existing conditions. Health insurance Portability and Accountability provides for settlement of claims for the members of in insurance by the United States Labor Department. It provides for the protection of rights of coverage under certain groups. It also protects the users from discrimination due to their medical conditions. Consolidated Omnibus Budget Reconciliation Act (COBRA) provides for workers that they can continue with their group health benefits for minimum periods because of certain unavoidable circumstances such as the loss of employment, divorce, death, paralysis and other occurrences, even after they lose such benefits.

In conclusion, the United States has an overall good and stable health system for their workers. However, there is a need for reform to address certain issues for those in service to the country. The United States government should give those in the line access or comprehensive insurance coverage. It is because; they dedicate their lives to defending the country, which is a very difficult task. Therefore, in turn the government should reciprocate such selfless actions and give them the dignity they deserve to access adequate and quality healthcare without pay or at considerable rates. Alternatively, the government can even provide more funding to programmes such as TRICARE to accommodate a larger bracket of people who serve this country with great pride and dedication of duty adequate healthcare


















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