TRICARE Health Plan

The TRICARE Health Plan manages and oversees an integrated health care delivery system in the East and West U.S. TRICARE regions. The THP Director reports to and operates under the authority, direction, and control of the Director, Defense Health Agency. The THP Director has visibility of both the contract and Click to closeDirect CareDirect care refers to military hospitals and clinics, also known as “military treatment facilities” and “MTFs.”direct care assets, and coordinates with the Services to develop an integrated health plan. THP includes:

Objectives

  • Deliver more comprehensive primary care and integrated health services using advanced patient-centered medical home
  • Coordinate care over time and across treatment settings to improve outcomes in the management of chronic illness, particularly for patients with complex medical and social problems.
  • Match personnel, infrastructure and funding to current missions, future missions and population demand
  • Establish more inter-Service standards / metrics, and standardize processes to promote learning and continuous improvement.
  • Create enhanced value in military medical markets using an integrated approach specified in five-year business performance plans.
  • Align incentives with health and readiness outcomes to reward value creation

TRICARE Health Plan Functions

We deliver health care to 9.5 million TRICARE beneficiaries through an integrated network comprised of military hospitals and clinics and civilian providers, and ensure consistency of care in accordance with statute via policy and regulations, benefit determination, and benefit design.

The THP manages the TRICARE contracts in each region. This responsibility includes:

  • Ensuring network quality and adequacy; resolves provider issues
  • Monitoring customer satisfaction outcomes
  • Managing customer service issues
  • Coordinating appointing and referral management policies
  • Addressing enrollment issues
  • Contracting and fiscal management functions
  • Establishing and coordinating regional marketing and education functions
  • Overseeing contractor credentialing
  • Developing TRICARE maximum allowable charge waiver packages
  • Approving resource sharing agreements with the regional contractor and military treatment facilities (MTFs)
  • Ensuring contract support for MTF optimization
  • Approving Memorandum of Understanding with the regional contractors
  • Serving as the award fee determination official for Health Care Services and Administration contracts
  • Other delegated functions

THP supports MTF Commanders in their delivery of health care services for MTF-enrolled beneficiaries, for the management of health care services for beneficiaries not enrolled to MTFs, supporting the MTF Commanders in their efforts to optimize health care services in the MTFs, and other assistance as required to support both MTF and remote areas to meet regional strategic planning goals and the annual business plan objectives

THP develops business plans to support all beneficiaries in each region, including non-MTF areas, remote areas, and those areas where the Service Surgeon Generals request THP Director support. Each individual business plan is integrated into a single, regional business plan that's submitted to the DHA Director each fiscal year. 

Customer Service

If you’re looking for details about your TRICARE plan, visit the TRICARE websiteGoes to the TRICARE website. There, you can:

In most cases, you'll call your regional contractor first:

TRICARE East TRICARE West

Humana Military

1-800-444-5445

TriWest Healthcare Alliance

1-888-TRIWEST (1-888-874-9378)

But there are times when you may need to call the DHA THP: 1-844-204-9351

Forms & Downloads

File  Description 
Guard/Reserve Briefing Request Form  Guard/Reserve units can submit this form to request a briefing from their regional contractor each year.
Supplemental Health Care Program Worksheet Use this worksheet when referring a service member under the Supplemental Health Care Program.
TRICARE Prime Remote Determination of Enrollment Eligibility Submit this form if you believe that one or more of the exceptions to the eligibility criteria for TRICARE Prime Remote enrollment are met. Only service members or unit commanders can submit this form.

You also may be interested in...

Policy
Aug 28, 2013

Memorandum: #13-009, Policy Memorandum to Establish 2014 Premium Rates for TRICARE Reserve Select and TRICARE Retired Reserve

.PDF | 699.45 KB

TRICARE Reserve Select (TRS) premium rates are established annually on a calendar year (CY) basis in accordance with Title 10, United States Code (U.S.C.), Section (Sec.) 1076d and Title 32, Code of Federal Regulations (CFR), Part 199.24. The TRS monthly premiums for CY 2014 shall be the rates listed in the table inside this document.

  • Identification #: 13-009
  • Type: Memorandum
Recommended Content TRICARE Health Plan Rates and Reimbursement
Policy
Aug 27, 2013

Memorandum: #13-008, Policy Memorandum to Establish 2014 Premium Rates for the Continued Health Care Benefit Program 13-008

.PDF | 610.41 KB

Continued Health Care Benefit Program (CHCBP) premium rates are established annually on a fiscal year (FY) basis in accordance with Title 10, United States Code, Section 1078a and Title 32, Code of Federal Regulations, Part 199.20. CHCBP quarterly premiums for FY 2014 shall be the rates listed in the table in this document

  • Identification #: 13-008
  • Type: Memorandum
Recommended Content TRICARE Health Plan Rates and Reimbursement
Policy
Aug 22, 2013

Memorandum: #13-007, Policy Memorandum to Establish 2014 Premium Rates for the TRICARE Young Adult Program 13-007

.PDF | 626.47 KB

TRICARE Young Adult premium rates are established annually on a calendar year (CY) basis in accordance with Title 10, United States Code, Section IIIOb and Title 32, Code of Federal Regulations, Part 199.26. TYA monthly premiums for CY 2014 shall be the rates listed in the table in this document.

  • Identification #: 13-007
  • Type: Memorandum
Recommended Content TRICARE Health Plan Rates and Reimbursement
Policy
Sep 24, 2012

Memorandum: #12-009, Guidelines for Suspension and Reinstatement of TRICARE Reserve Select Coverage

.PDF | 1.18 MB

This memorandum clarifies the procedures under title 32 of the Code of Federal Regulations, section 199.24(d)(3) for suspending TRICARE Reserve Select (TRS) coverage for up to 12 months and, upon request from a TRS member/survivor request, lifting the suspension, which will reinstate coverage with no break.

  • Identification #: 12-009
  • Type: Memorandum
Recommended Content Health Care Administration & Operations TRICARE Health Plan
Policy
Feb 4, 2011

Memorandum: # HA Policy 02-2011, Clear and Legible Report Process

.PDF | 2.76 MB

The purpose of this Policy Memorandum is to document unifonn business rules for managing the Clear and Legible Report (CLR) process and incorporate these business rules as standard operating procedures at all Referral Management Centers (RMC).

  • Identification #: HA Policy 02-2011
  • Type: Memorandum
Recommended Content TRICARE Health Plan