Covered Care Required | TRICARE Select Pays(1) | TRICARE Select Supplement Plan Pays |
Inpatient confinement(2) in civilian hospitals for RETIREES and dependent family members (room, board, supplies and staff services billed by the hospital) | The TRICARE Select DRG(3) amount (contracted rate for TRICARE Extra)minus your cost share. | The lesser of the DRG/day or 25% of billed amount, not to exceed the TRICARE Select DRG amount (lesser of $250/day or 25% cost share of the contracted rate for TRICARE Extra) (AFTER you satisfy the fiscal year plan deductible.) |
Inpatient confinement in civilian hospitals for RETIREES and dependent family members (doctors, and other inpatient services not billed by the hospital) | 75% of the TRICARE Select allowed amount (80% for TRICARE Extra) for doctors and other professional services. | Your cost share AFTER you satisfy the fiscal year plan deductible. |
Inpatient confinement in military hospitals. | All but the daily subsistence fee. | The daily subsistence fee. |
Outpatient care for RETIREES and dependent family members (office visits, clinics, lab, prescription drugs, etc.) | 75% of the TRICARE Select allowed amount (80% for TRICARE Extra) after you pay the TRICARE Outpatient Deductible. | Your cost share AFTER you satisfy the fiscal year plan deductible PLUS 100% of Covered Excess Charges up to the TRICARE Legal Limit.
For prescription drugs - the plan pays your copayment amounts. |
Inpatient confinement in civilian hospitals for ACTIVE DUTY dependents. | All allowable charges except daily subsistence fee or $25, whichever is greater. | Active Duty Plan - $25 or the daily subsistence fee, whichever is greater. |
Outpatient care for ACTIVE DUTY dependents (office visits, clinics, lab, prescription drugs, etc.). | 80% of the TRICARE Select allowed amount (85%) for TRICARE Extra) after you pay the TRICARE Outpatient Deductible. | Active Duty Plan - Your cost share PLUS 100% of covered excess charges up to the TRICARE Legal Limit.For prescription drugs - the plan pays your copayment amounts. |