Military Health System

1.1  TRICARE Plus is a service-directed primary care enrollment program that is available at selected Military Medical Treatment Facilities (MTFs). Local MTF Commanders Directors determine whether TRICARE Plus shall be offered based on their facility’s capacities, capabilities, and mission.

1.2  All TRICARE requirements regarding TRICARE Plus shall apply to the TOP unless specifically changed, waived, or superseded by the provisions of this section; the TRICARE Policy Manual (TPM), Chapter 12; or the TRICARE contract for health care support services outside the 50 United States (US) and the District of Columbia (hereinafter referred to as the “TOP contract”). See Chapter 6, Section 4 for additional instructions.

3.1  All beneficiary inquiries regarding TRICARE Plus enrollment/disenrollment shall be directed to the TOP contractor’s toll-free number or, based on the Statement of Responsibility (SOR) with each MTF Commander Director, to the designated MTF Point of Contact (POC) for TRICARE Plus. This shall include questions about TRICARE Plus, general questions about enrollment/disenrollment, providing enrollment/disenrollment forms, providing information about the availability of TRICARE Plus at a particular MTF, the extent of coverage available and not available through TRICARE Plus, the selection of individual Primary Care Coordinators (PCCs), or confirmation of enrollment/disenrollment.

3.2  MTFs will approve or disapprove requests for TRICARE Plus enrollment and for managing Primary Care Clinic capacity for TRICARE Plus enrollment. The MTF will ensure that TRICARE Plus enrollment forms are completed with validated eligibility through the Defense Enrollment Eligibility Reporting System (DEERS). The MTFs will send all completed and approved TRICARE Plus enrollment/disenrollment forms to the TOP contractor no less frequently than weekly.

3.3  The TOP contractor shall ensure that all TRICARE Plus enrollments are entered through the Government furnished web-based system/application. The contractor shall return incomplete forms or any application for which enrollment/disenrollment cannot be effected, for any reason other than internal contractor systems or process problems, to the MTF for completion/correction. The contractor shall make no effort to correct or complete any TRICARE Plus enrollment/disenrollment application.

3.4  TOP Prime and TOP Prime Remote cannot be used in conjunction with TRICARE Plus. Enrollment in TRICARE Plus will necessitate disenrollment from TOP Prime or TOP Prime Remote.

3.5  TRICARE Plus enrollment to an overseas MTF is effective on the date the enrollment application is approved by the MTF.

5.1  TRICARE Plus is an MTF primary care access program, not a health plan. TRICARE Plus enrollment has no impact on care received from civilian providers. Claims The TOP contractor shall process claims for care rendered to TRICARE Select/TRICARE Plus enrollees by civilian providers shall be processed according to the TRICARE Reimbursement Manual (TRM). This includes care rendered by private sector care providers overseas or civilian providers in the US and the District of Columbia.

5.2  The TOP contractor shall not develop private sector care provider networks to support the TRICARE Plus beneficiary population.

5.3  The TOP contractor shall not provide Guarantee of Payment to private sector care providers or institutions for TRICARE Plus enrollees.

5.4  The TOP contractor shall not make appointments with private sector care providers for TRICARE Plus enrollees. However, upon beneficiary request, the contractor shall provide the beneficiary with the name, telephone number, and address of network or non-network providers of the appropriate clinical specialty located within the beneficiary’s geographic location.