1.3.1 Deductible
Amount: Outpatient Care
1.3.1.1 Active
Duty Sponsor in Pay Grade E-4 or Below
1.3.1.1.1 Deductible, Individual: Each
beneficiary is liable for the first fifty dollars ($50.00) of the allowable
amount on claims for care provided in the same fiscal year.
1.3.1.1.2 Deductible, Family: The total
deductible amount for all members of a family with the same sponsor
during one fiscal year shall not exceed one hundred dollars ($100.00).
1.3.1.2
All
TRICARE Beneficiaries Except Family Members of Active Duty Sponsors
in Pay Grade E-4 or Below
1.3.1.2.1 Deductible, Individual: Each
beneficiary is liable for the first $150.00 of the allowable amount
on claims for care provided in the same fiscal year.
1.3.1.2.2 Deductible, Family: The total
deductible amount for all members of a family with the same sponsor
during one fiscal year shall not exceed $300.00.
1.3.1.3 TRICARE-Approved Ambulatory
Surgery Centers (ASCs), Birthing Centers, or Partial Hospitalization
Programs (PHPs)
1.3.1.3.1 TRICARE-Approved Ambulatory
Surgery Centers (ASCs), Birthing Centers, or Partial Hospitalization
Programs (PHPs). No deductible shall be applied to allowable amounts
for services or items rendered to ADFMs. For family members of active
duty members of the armed forces of NATO/PfP foreign nations who
are eligible for outpatient care under TRICARE, see
paragraph 1.1.5 for
deductible and cost-share information.
1.3.1.3.2 Allowable
Amount Does Not Exceed Deductible Amount. If fiscal year allowable amounts
for two or more beneficiary members of a family total less than
$100.00 (or $300.00 if
paragraph 1.3.1.2, applies), and no one beneficiary’s
allowable amounts exceed $50.00 (or $150.00 if
paragraph 1.3.1.2 applies),
neither the family nor the individual deductible will have been
met and no TRICARE benefits are payable.
1.3.1.3.3 In
the case of family members of an active duty member of pay grade
E-5 or above, with Persian Gulf conflict service who is, or was,
entitled to special pay for hostile fire/imminent danger authorized
by 37 USC 310, for services in the Persian Gulf area in connection
with Operation Desert Shield or Operation Desert Storm, the deductible
shall be the amount specified in
paragraph 1.3.1.2.
Note: The provisions of
paragraph 1.3.1.3.3,
also apply to family members of Service members who were killed
in the Gulf, or who died subsequent to Gulf service; and to Service
members who retired prior to October 1, 1991, after having served
in the Gulf war, and to their family members.
1.3.1.3.4 Adjustment of Excess. Any beneficiary
identified under
paragraphs 1.3.1.3.2 and
1.3.1.3.3 who
paid any deductible in excess of the amounts stipulated is entitled
to an adjustment of any amount paid in excess against the annual
deductible required under those paragraphs.
1.3.1.3.5 The deductible amounts identified
in this section shall be deemed to have been satisfied if the catastrophic
cap amounts identified in
Section 2 have
been met for the same fiscal year in which the deductible applies.
1.3.3 Cost-Share Amount
1.3.3.1 Outpatient
Care
1.3.3.1.1 The cost-share for ADFMs for
outpatient care is 20% of the allowable amount in excess of the
annual deductible amount. This includes the professional charges
of an individual professional provider for services rendered in
a non-TRICARE-approved ASC or Birthing Center. For family members of
active duty members of the armed forces of NATO/PfP foreign nations
who are eligible for outpatient care under TRICARE per DEERS, see
paragraph 1.1.5.
1.3.3.1.2 Other Beneficiary. The cost-share
applicable to outpatient care for other than active duty and authorized
NATO/PfP family member beneficiaries is 25% of the allowable amount
in excess of the annual deductible amount. This includes: partial
hospitalization for alcohol rehabilitation; professional charges
of an individual professional provider for services rendered in
a non-TRICARE-approved ASC.
1.3.3.2
Inpatient
Care
1.3.3.2.1 ADFM:
For services prior to October 3, 2016, except in the case of mental
health and Substance Use Disorder (SUD) services, ADFMs or their
sponsors are responsible for the payment of the first $25 of the
allowable institutional costs incurred with each covered inpatient
admission to a hospital or other authorized institutional provider,
or the daily charge the beneficiary or sponsor would have been charged
had the inpatient care been provided in a Uniformed Service hospital,
whichever is greater. (Please reference daily rate chart below.)
For services on or after October 3, 2016, the following applies
to all services (to include mental health and SUD services) for
ADFMs or their sponsors.
Figure 2.1-1 Uniformed
Services Hospital Daily Charge Amounts
|
Period
|
Daily Charge
|
|
Use the daily charge (per diem
rate) in effect for each day of the stay to calculate a cost-share
for a stay which spans periods.
|
|
October
1, 2017 - September 30, 2018 (for ADFMs not enrolled in Prime)
|
$18.60
|
|
October 1, 2018 - December
31, 2019 (for ADFMs not enrolled in Prime)
|
$19.05
|
|
January 1, 2020 - December
31, 2020 (for ADFMs not enrolled in Prime)
|
$19.55
|
|
January 1, 2021-
December 21, 2021 (for ADFMs not enrolled in Prime)
|
$20.15
|
1.3.3.2.2 Other
Beneficiaries: For services exempt from the DRG-based payment system
and the mental health per diem payment system and services provided
by institutions other than hospitals (i.e., Residential Treatment
Centers (RTCs)), the cost-share shall be 25% of the allowable charges.
1.3.3.3
Cost-Shares:
Maternity
1.3.3.3.1 Determination.
Maternity care cost-share shall be determined as follows:
1.3.3.3.1.1 Inpatient cost-share formula
applies to maternity care ending in childbirth in, or on the way
to, a hospital inpatient childbirth unit, and for maternity care
ending in a non-birth outcome not otherwise excluded.
Note: Inpatient cost-share formula
applies to prenatal and postnatal care provided in the office of a
civilian physician or certified nurse-midwife in connection with
maternity care ending in childbirth or termination of pregnancy
in, or on the way to, a Military Treatment Facility (MTF)/Enhanced
Multi-Service Market (eMSM) inpatient childbirth unit. ADFMs pay
a per diem charge (or a $25.00 minimum charge) for an admission
and there is no separate cost-share for them for separately billed
professional charges or prenatal or postnatal care.
1.3.3.3.1.2 Ambulatory surgery cost-share
formula applies to maternity care ending in childbirth in, or on
the way to, a birthing center to which the beneficiary is admitted,
and from which the beneficiary has received prenatal care, or a
hospital-based outpatient birthing room.
1.3.3.3.1.3 Outpatient cost-share formula
applies to maternity care which terminates in a planned childbirth
at home.
1.3.3.3.1.4 Otherwise covered medical services
and supplies directly related to “complications of pregnancy”, as
defined in the Regulation, shall be cost-shared on the same basis
as the related maternity care for a period not to exceed 42 days
following termination of the pregnancy and thereafter cost-shared
on the basis of the inpatient or outpatient status of the beneficiary
when medically necessary services and supplies are received.
1.3.3.3.2 Otherwise authorized services
and supplies related to maternity care, including maternity related
prescription drugs, shall be cost-shared on the same basis as the
termination of pregnancy.
1.3.3.3.3 Claims for pregnancy
testing shall be cost-shared on an outpatient basis when
the delivery is on an inpatient basis.
1.3.3.3.4 Where the beneficiary delivers
in a professional office birthing suite located in
the office of a physician or certified nurse-midwife (which is not
otherwise a TRICARE-approved birthing center) the delivery shall
be adjudicated as an at-home birth.
1.3.3.3.5 Claims for prescription
drugs provided on an outpatient basis during the maternity episode
but not directly related to the maternity care shall be cost-shared
on an outpatient basis.
1.3.3.3.6 Newborn cost-share. Effective
for all inpatient admissions occurring on or after October 1, 1987,
separate claims must be submitted for the mother and newborn. The
cost-share for inpatient claims for services rendered to a beneficiary
newborn is determined as follows:
1.3.3.3.6.1 In a DRG hospital:
1.3.3.3.6.1.1 Same
newborn date of birth and date of admission:
• For
ADFMs, there shall be no cost-share during the period the newborn
is deemed enrolled in Prime.
• For
newborn family members of other than active duty members, unless
the newborn is deemed enrolled in Prime, the cost-share shall be
the lower of the number of hospital days minus three multiplied
by the per diem amount, OR 25% of the total billed charges (less
duplicates and DRG non-reimbursables such as hospital-based professional
charges).
1.3.3.3.6.1.2 Different newborn date of birth
and date of admission:
• For
ADFMs, there shall be no cost-share during the period the newborn
is deemed enrolled in Prime.
• For
all other beneficiaries, the cost-share shall be applied to all
days in the inpatient stay unless the newborn is deemed enrolled
in Prime.
1.3.3.3.6.2 In DRG exempt hospital:
1.3.3.3.6.2.1 Same
newborn date of birth and date of admission:
• For
ADFMs, there shall be no cost-share during the period the newborn
is deemed enrolled in Prime.
• For
family members of other than active duty members, the cost-share
shall be calculated based on 25% of the total allowed charges unless
the newborn is deemed enrolled in Prime.
1.3.3.3.6.2.2 Different
newborn date of birth and date of admission:
• For
ADFMs, there shall be no cost-share during the period the newborn
is deemed enrolled in Prime.
• For
family members of other than active duty members, the cost-share
shall be calculated based on 25% of the total allowed charges unless
the newborn is deemed enrolled in Prime.
1.3.3.3.7 Maternity Related Care. Medically
necessary treatment rendered to a pregnant woman for a non-obstetrical
medical, anatomical, or physiological illness or condition shall
be cost-shared as a part of the maternity episode when:
• The treatment
is otherwise allowable as a benefit; and
• Delay
of the treatment until after the conclusion of the pregnancy is
medically contraindicated; and
• The illness
or condition is, or increases the likelihood of, a threat to the
life of the mother; or
• The
illness or condition will cause, or increase the likelihood of,
a stillbirth or newborn injury or illness; or
• The usual
course of treatment must be altered or modified to minimize a defined risk
of newborn injury or illness.
1.3.3.4
Cost-Shares:
DRG-Based Payment System
1.3.3.4.1 General
These special cost-sharing
procedures apply only to claims paid under the DRG-based payment
system.
1.3.3.4.2
TRICARE
Standard
1.3.3.4.2.1 Cost-shares for ADFMs. ADFMs
or their sponsors are responsible for the payment of the first $25
of the allowable institutional costs incurred with each covered
inpatient admission to a hospital or other authorized institutional
provider, or the amount the beneficiary or sponsor would have been
charged had the inpatient care been provided in a Uniformed Service
hospital, whichever is greater.
1.3.3.4.2.2 Cost-shares for beneficiaries
other than ADFMs.
1.3.3.4.2.2.1 The cost-share shall be the
lesser of:
1.3.3.4.2.2.1.1 An
amount based on a single, specific per diem amount which will not
vary regardless of the DRG involved. The following is the DRG inpatient
TRICARE Standard cost-sharing per diems for beneficiaries other
than ADFMs.
1.3.3.4.2.2.1.1.1 The
per diem amount will be calculated as follows:
• Determine
the total allowable DRG-based amounts for services subject to the
DRG-based payment system and for beneficiaries other than ADFMs during
the same database period used for determining the DRG weights and
rates.
• Add in the allowance for Capital
and Direct Medical Education (CAP/DME) which have been paid to hospitals
during the same database period used for determining the DRG weights
and rates.
• Divide this amount by the total
number of patient days for these beneficiaries. This amount will
be the average cost per day for these beneficiaries.
• Multiply
this amount by 0.25. In this way total cost-sharing amounts will continue
to be 25% of the allowable amount.
• Determine
any cost-sharing amounts which exceed 25% of the billed charge (see
paragraph 1.3.3.4.2.2.1.2) and divide this
amount by the total number of patient days in
paragraph 1.3.3.4.2.2.1.1).
Add this amount to the amount in
paragraph 1.3.3.4.2.2.1.1. This is the per
diem cost-share to be used for these beneficiaries.
1.3.3.4.2.2.1.1.2 The
per diem amount shall be required for each actual day of the beneficiary’s hospital
stay which the DRG-based payment covers except for the day of discharge.
When the payment ends on a specific day because eligibility ends
on a short-stay outlier day, the last day of eligibility is to be
counted for determining the per diem cost-sharing amount. For claims
involving a same-day discharge which qualify as an inpatient stay
(e.g., the patient was admitted with the expectation of a stay of
several days, but died the same day) the cost-share is to be based
on a one-day stay. (The number of hospital days must contain one
day in this situation.)
1.3.3.4.2.2.1.2 Twenty-five
percent (25%) of the billed charge. The billed charge to be used includes
all inpatient institutional line items billed by the hospital minus
any duplicate charges and any charges which can be billed separately
(e.g., hospital-based professional services, outpatient services, etc.).
The net billed charges for the cost-share computation include comfort
and convenience items.
1.3.3.4.2.2.2 Under no circumstances can
the cost-share exceed the DRG-based amount.
1.3.3.4.2.2.3 Where the dates of service
span different fiscal years, the per diem cost-share amount for
each year is to be applied to the appropriate days of the stay.
1.3.3.4.3 TRICARE Extra
1.3.3.4.3.1 Cost-shares for ADFMs. The
cost-sharing provisions for ADFMs are the same as those for TRICARE
Standard.
1.3.3.4.3.2 Cost-shares for beneficiaries
other than ADFMs. The cost-sharing provisions for beneficiaries
other than ADFMs is the same as those for TRICARE Standard, except
the per diem copayment is $250.
1.3.3.4.4 TRICARE
Prime
There
is no cost-share for ADFMs. For beneficiaries other than ADFMs,
the cost-sharing provision is the first $25 of the allowable institutional
costs incurred with each covered inpatient admission to a hospital
or other authorized institutional provider, or a per diem rate of
$11, whichever is greater.
1.3.3.4.5 Maternity
Services
See
paragraph 1.3.3.3,
for the cost-sharing provisions for maternity services.
1.3.3.5 Cost-Shares: Inpatient Mental
Health Per Diem Payment System
1.3.3.5.1 General. These special cost-sharing
procedures apply only to claims paid under the inpatient mental
health per diem payment system. For inpatient claims exempt from
this system, the procedures in
paragraph 1.3.3.2 or
1.3.3.4 are to be followed.
1.3.3.5.2 Cost-shares for ADFMs. For
dates of service prior to October 3, 2016, inpatient cost-sharing
for mental health services is $20 per day for each day of the inpatient
admission. This $20 per day cost-share applies to admissions to
any hospital for mental health services, any RTC, any Substance Use
Disorder Rehabilitation Facility (SUDRF), and any PHP providing
mental health or SUD rehabilitation services. For Prime ADFMs cost-share
is $0 per day. See
Addendum A for further information.
1.3.3.5.3 For dates of service on or
after October 3, 2016, the inpatient cost-sharing for mental health
services is that described in
paragraph 1.3.3.2.1. The cost-share applies
to admissions to any hospital for mental health services, any RTC,
and any inpatient/residential SUD detoxification and rehabilitation
program. For Prime ADFMs, the cost-share is $0 per day. See
Addendum A for further information.
1.3.3.5.4 Cost-shares for beneficiaries
other than ADFMs.
1.3.3.5.4.1 Higher volume hospitals and
units. With respect to care paid for on the basis of a hospital
specific per diem, the cost-share shall be 25% of the hospital specific
per diem amount.
1.3.3.5.4.2 Lower
volume hospitals and units. For care paid for on the basis of a
regional per diem, the cost-share shall be the lower of
paragraphs 1.3.3.5.4.2.1 or
1.3.3.5.4.2.2:
1.3.3.5.4.2.1 A
fixed daily amount multiplied by the number of covered days. The
fixed daily amount shall be 25% of the per diem adjusted so that
total beneficiary cost-shares will equal 25% of total payments under
the inpatient mental health per diem payment system. This fixed
daily amount shall be updated annually and on the DHA website at
http://www.health.mil/rates.
This fixed daily amount will also be furnished to contractors by
the DHA. The following fixed daily amounts are effective for services
rendered on or after October 1 of each fiscal year.
• FY 2019 - $248 per day.
• FY 2020 - $255 per day.
• FY 2021 - $261 per day.
1.3.3.5.4.2.2 Twenty-five
percent (25%) of the hospital’s billed charges (less any duplicates).
1.3.3.5.5 Claims which span a period
in which two separate per diems exist. A claim subject to the inpatient
mental health per diem payment system which spans a period in which
two separate per diems exist shall have the cost-share computed
on the actual per diem in effect for each day of care.
1.3.3.5.6 Cost-share whenever leave days
are involved. There is no patient cost-share for leave days when
such days are included in a hospital stay.
1.3.3.5.7 Claims
for services that are provided during an inpatient admission which
are not included in the per diem rate shall be cost-shared as an
inpatient claim if the contractor cannot determine where the service
was rendered and the status of the patient when the service was provided.
The contractor shall examine the claim for place of service and
type of service to determine if the care was rendered in the hospital
while the beneficiary was an inpatient of the hospital. This would include
non-mental health claims and mental health claims submitted by individual
professional providers rendering medically necessary services during
the inpatient admission.
1.3.3.6 Cost-Shares: PHPs And Intensive
Outpatient Program (IOPs)
1.3.3.6.1 For care rendered prior to
October 3, 2016, cost-sharing for partial hospitalization is on an
inpatient basis. The inpatient cost-share also applies to the associated
psychotherapy billed separately by the individual professional provider.
These providers shall identify on the claim form that the psychotherapy
is related to a partial hospitalization stay so the proper inpatient
cost-sharing can be applied. The cost-share for ADFMs enrolled in
Prime for inpatient mental health services is $0. For retirees and
their family members, the cost-share is 25% of the allowed amount.
Since inpatient cost-sharing is being applied, no deductible shall
be taken for partial hospitalization regardless of sponsor status.
The cost-share for ADFMs shall be taken from the PHP claim.
1.3.3.6.2 For
care rendered on or after October 3, 2016, cost-sharing for PHPs
and IOPs is on an outpatient basis. The outpatient cost-share also
applies to the associated psychotherapy billed separately by the
individual professional provider. These providers shall identify
on the claim form that the psychotherapy is related to PHP or IOP
care so the proper outpatient cost-sharing can be applied. Cost-shares
for standard beneficiaries can be found in
paragraph 1.3; cost-sharing
requirements for prime beneficiaries can be found in
paragraph 1.2.
1.3.3.7
Cost-Shares:
Ambulatory Surgery
1.3.3.7.1 For
non-TRICARE Prime ADFMs, for all services reimbursed as ambulatory
surgery, the cost-share shall be $25 and shall be assessed on the
facility claim. No cost-share shall be deducted from a claim for
professional services related to ambulatory surgery. This applies
whether the services are provided in a freestanding ASC, a hospital
outpatient department or a hospital emergency room. So long as at
least one procedure on the claim is reimbursed as ambulatory surgery,
the claim shall be cost-shared as ambulatory surgery as required
by this section. For family members of active duty members of the
armed forces of NATO/PfP foreign nations who are eligible for outpatient
care under TRICARE per DEERS, see
paragraph 1.1.5.
1.3.3.7.2 Other Beneficiaries. Since
the cost-share for other beneficiaries is based on a percentage
rather than a set amount, the cost-share shall be taken from all
ambulatory surgery claims. For professional services, the cost-share
is 25% of the allowed amount. For the facility claim, the cost-share
is the lesser of:
1.3.3.7.2.1 Twenty-five percent (25%) of
the applicable group payment rate (see
Chapter 9, Section 1);
or
1.3.3.7.2.2 Twenty-five percent (25%) of
the billed charges; or
1.3.3.7.2.3 Twenty-five percent (25%) of
the allowed amount as determined by the contractor.
1.3.3.7.2.4 The special cost-sharing provisions
for beneficiaries other than ADFMs will ensure that these beneficiaries
are not disadvantaged by these procedures. In most cases, 25% of
the group payment rate will be less, but because there is some variation
within each group, 25% of billed charges could be less in some cases.
This will ensure that the beneficiaries get the benefit of the group
payment rates when they are more advantageous, but they will never
be disadvantaged by them. If there is no group payment rate for
a procedure, the cost-share shall simply be 25% of the allowed amount.
1.3.3.8 Cost-Shares and Deductible:
Former Spouses
1.3.3.8.1 Deductible.
In accordance with the FY 1991 Appropriations and Authorization
Acts, Sections 8064 and 712 respectively, beginning April 1, 1991,
an eligible former spouse is responsible for payment of the first
one hundred and fifty dollars ($150.00) of the reasonable costs/charges
for otherwise covered outpatient services and/or supplies provided
in any one fiscal year. Although the law defines former spouses
as family members of the member or former member, there is no legal familial
relationship between the former spouse and the member or former
member. Moreover, any TRICARE-eligible children of the former spouse
will retain a legal familial relationship with the member or former
member and shall be included in the member’s or former member’s
family deductible. The former spouse cannot contribute to, nor benefit
from, any family deductible of the member or former member to whom
the former spouse was married or of that of any TRICARE-eligible
children. In other words, a former spouse must independently meet
the $150.00 deductible in any fiscal year.
1.3.3.8.2 Cost-Share. An eligible former
spouse is responsible for payment of cost-sharing amounts identical
to those required for beneficiaries other than ADFMs.
1.3.3.9 Cost-Share Amount: Under Discounted
Rate Agreements
Under
managed care, where there is a negotiated (discounted) rate agreed
to by the network provider, the cost-share shall be based on the
following:
1.3.3.9.1 For
non-institutional providers providing outpatient care, and for institution-based professional
providers rendering both inpatient and outpatient care; the cost-share
(20%) for outpatient care to ADFMs, 25% for care to all others)
shall be applied to (after duplicates and noncovered charges are
eliminated), the lowest of the billed charge, the prevailing charge,
the maximum allowable prevailing charge (the Medicare Economic Index
(MEI) adjusted prevailing), or the negotiated (discounted) charge.
1.3.3.9.2 For institutional providers
subject to the DRG-based reimbursement methodology, the cost-share
for beneficiaries other than ADFMs shall be the LOWER OF EITHER:
• The single,
specific per diem supplied by DHA after the application of the agreed upon
discount rate; OR
• Twenty-five percent (25%) of
the billed charge.
1.3.3.9.3 For institutional providers
subject to the Mental Health Per Diem Payment System (high volume
hospitals and units), the cost-share for beneficiaries other than
ADFMs shall be 25% of the hospital per diem amount after it has
been adjusted by the discount.
1.3.3.9.4 For institutional providers
subject to the Mental Health per diem payment system (low volume
hospitals and units), the cost-share for beneficiaries other than
ADFMs shall be the LOWER OF EITHER:
• The fixed
daily amount supplied by DHA after the application of the agreed
upon discount rate; OR
• Twenty-five
percent (25%) of the billed charge.
1.3.3.9.5 For RTCs, the cost-share for
other than ADFMs shall be 25% of the TRICARE rate after it has been
adjusted by the discount.
1.3.3.9.6 For institutions and for institutional
services being reimbursed on the basis of the TRICARE-determined
reasonable costs, the cost-share for beneficiaries other than ADFMs
shall be 25% of the allowable billed charges after it has been adjusted
by the discount.
Note: For
all inpatient care for ADFMs, the cost-share shall continue to be
either the daily charge or $25 per stay, whichever is higher. There
is no change to the requirement for the ADFM’s cost-share to be
applied to the institutional charges for inpatient services. If
the contractor learns that the participating provider has billed
a beneficiary for a greater cost-share amount, based on the provider’s usual
billed charges, the contractor shall notify the provider that such
an action is a violation of the provider’s signed agreement. (Also
see
paragraph 1.3.3.4.) For Prime ADFMs, the cost-share
is $0 for care provided on or after April 1, 2001.
1.3.3.10
Preventive
Services
1.3.3.10.1 No copayments or authorizations
are required for the following preventive services as described
in the TPM,
Chapter 7, Sections 2.1 and
2.5:
1.3.3.10.1.1 Colorectal
cancer screening.
1.3.3.10.1.2 Breast cancer screening.
1.3.3.10.1.3 Cervical cancer screening.
1.3.3.10.1.4 Prostate cancer screening.
1.3.3.10.1.5 Immunizations.
1.3.3.10.1.6 Well-child visits for children
under six years of age.
1.3.3.10.2 In addition to the services
listed in
paragraph 1.3.3.10.1, effective January 1,
2017, cost-shares are eliminated for the services listed in the
TPM,
Chapter 7, Section 2.1, paragraphs 1.1.1.1.2 and
1.1.5.1 through
1.1.5.12.
Effective January 1, 2018, cost-shares are eliminated for the services
listed in the TPM,
Chapter 7, Section 2.1, paragraph 1.1.5.13.
1.3.3.10.3 A beneficiary is not required
to pay any portion of the cost of these preventive services even
if the beneficiary has not satisfied the deductible for that year.
1.3.3.10.4 This waiver does not apply
to any TRICARE beneficiary who is a Medicare-eligible beneficiary.