Care Required | TRICARE Reserve Select Pays(1) | TRICARE Reserve Select Supplement Plan Pays |
Government Hospital | All TRICARE Reserve Select Allowed Amount except the Daily Subsistence Fee | Current Daily Subsistence Charge |
Civilian Hospital or Skilled Nursing Facility | All TRICARE Reserve Select Allowed Amount except the Daily Subsistence Fee or $25, whichever is greater | The greater of: 1) Current Daily Subsistence Charge for each day of confinement(b); or 2) $25.00 for all
Confinements which are due to the same or related Sickness or Injury and separated by less than 60 days; until the
TRICARE Cap(b) is met; |
Outpatient(d) Visit | TRICARE Network Provider 85% of the TRICARE allowable charge after the annual deductible(c) is met
TRICARE Authorized Non-Network Provider 80% of the TRICARE allowable charge after the annual deductible(c) is met | TRICARE Network Provider Your 15% cost share for covered expenses until the TRICARE Cap is met
TRICARE Authorized Non-Network Provider Your 20% cost share PLUS 100% of the Covered Excess Charges up to the Legal Limit(e) |
Prescription Drug Charges(f) | Home Delivery: All but the copayments of $7 generic, $24 brand name, or $53 non-formulary
Network Retail (up to 30-day supply): All but the copayments of $11 generic, $28 brand name, or $53 non-formulary | Home Delivery: Copayments of $7 generic, $24 brand name, or $53 non-formulary
Network Retail (up to 30-day supply): Copayments of $11 generic, $28 brand name, or $53 non-formulary |
Non-Network Pharmacy(f) | All but $24 or 20% of the total cost for generic/brand name or $50 or 20% for non-formulary
(whichever is greater) after the fiscal year deductible | Copayments of $28 or 20% of the total cost for generic/brand name or $53 or 20% for non-formulary
(whichever is greater) after the fiscal year deductible |