TRICARE Reimbursement Manual 6010.61-M, April 1, 2015 Chapter 2 Beneficiary Liability Revision: C-52, December 24, 2020 Section/Addendum Subject/Addendum Title 1 Cost-Shares And Deductibles For TRICARE Services Received Prior To January 1, 2018 And For TRICARE Services Received On Or After January 1, 2018 By TRICARE For Life (TFL) Beneficiaries Figure 2.1-1 Uniformed Services Hospital Daily Charge Amounts 2 Cost-Shares And Deductibles For TRICARE Services Received On Or After January 1, 2018 Figure 2.2-1 TRICARE Select Deductibles for CY 2018 Figure 2.2-2 TRICARE Prime Cost-Shares for Preventive Care Visits Figure 2.2-3 TRICARE Select Cost-Shares for Preventive Care Visits Figure 2.2-4 TRICARE Prime Cost-Shares for Primary Care Outpatient Visits Figure 2.2-5 TRICARE Select Cost-Shares for Primary Care Outpatient Visits Figure 2.2-6 TRICARE Prime Cost-Shares for Specialty Care Outpatient Visits Figure 2.2-7 TRICARE Select Cost-Shares for Specialty Care Outpatient Visits Figure 2.2-8 TRICARE Select Cost-Shares for Ancillary Services Figure 2.2-9 TRICARE Select Cost-Shares for Other Radiology Services Figure 2.2-10 TRICARE Prime Cost-Shares for Eye Examinations Figure 2.2-11 TRICARE Select Cost-Shares for Eye Examinations Figure 2.2-12 TRICARE Prime Cost-Shares for Emergency Room (ER) Visits Figure 2.2-13 TRICARE Select Cost-Shares for Emergency Room (ER) Visits Figure 2.2-14 TRICARE Prime Cost-Shares for Urgent Care Center (UCC) Visits Figure 2.2-15 TRICARE Select Cost-Shares for Urgent Care Center (UCC) Visits Figure 2.2-16 TRICARE Prime Cost-Shares for Ambulatory Surgery (Including Birthing Centers) Figure 2.2-17 TRICARE Select Cost-Shares for Ambulatory Surgery (Including Birthing Centers) Figure 2.2-18 TRICARE Prime Cost-Shares for Ambulance Services (Including Birthing Centers) Figure 2.2-19 TRICARE Select Cost-Shares for Ambulance Services Figure 2.2-20 TRICARE Prime Cost-Shares for Durable Medical Equipment (DME) Figure 2.2-21 TRICARE Select Cost-Shares for Durable Medical Equipment (DME) Figure 2.2-22 TRICARE Prime Cost-Shares for Inpatient Hospitalizations Figure 2.2-23 TRICARE Select Cost-Shares for Inpatient Hospitalizations Figure 2.2-24 TRICARE Prime Cost-Shares for Skilled Nursing/Rehabilitation Facilities Figure 2.2-25 TRICARE Select Cost-Shares for Skilled Nursing/Rehabilitation Facilities Figure 2.2-26 TRICARE Prime Cost-Shares for Maternity - Hospital Delivery Figure 2.2-27 TRICARE Select Cost-Shares for Maternity - Hospital Delivery Figure 2.2-28 TRICARE Prime Cost-Shares for Maternity - Birthing Center Figure 2.2-29 TRICARE Select Cost-Shares for Maternity - Birthing Center Figure 2.2-30 TRICARE Prime Cost-Shares for Maternity - Home Delivery Figure 2.2-31 TRICARE Select Cost-Shares for Maternity - Home Delivery 3 Catastrophic Loss Protection For TRICARE Services Received Prior To January 1, 2018; And For TRICARE Services Received On Or After January 1, 2018, By TRICARE For Life (TFL) Beneficiaries 4 Catastrophic Loss Protection For TRICARE Services Received On Or After January 1, 2018 5 Point Of Service (POS) Option 6 Waivers of Cost-Shares and Deductibles 7 Temporary Waivers of Copayments and Cost-Shares (Including Deductibles) in Response to Coronavirus 2019 (COVID-19) Pandemic A Benefits And Beneficiary Payments Under The TRICARE Program For Services Received Prior To January 1, 2018; And For TRICARE Services Received On Or After January 1, 2018 By TRICARE For Life (TFL) Beneficiaries B Pharmacy Benefits Program - Cost-Shares Figure 2.B-1 Pharmacy Payment Matrix - Calendar year 2020/2021 Cost-Shares Figure 2.B-2 Pharmacy Payment Matrix - Calendar Year 2018/2019 Cost-Shares Figure 2.B-3 Pharmacy Payment Matrix - Fiscal Year 2017 Cost-Shares