HM NWAE TRICARE Programs 2025 Study Guide

Vocabulary practice cards for Hospital Corpsmen preparing for the 2025 Navy-Wide Advancement Exam (NWAE) based on current TRICARE policy handbooks.

TRICARE Prime

A managed care option for Active Duty Service Members (ADSMs) requiring enrollment and care at military hospitals and clinics, offering comprehensive coverage with professional referrals needed for specialty care.

TRICARE Select

A fee-for-service plan allowing beneficiaries to see any TRICARE-authorized provider without a referral, though certain services like inpatient mental health require prior authorization.

TRICARE For Life (TFL)

Medicare-wraparound coverage for military retirees and eligible family members with Medicare Part A and Part B, where Medicare is the primary payer and TRICARE is the secondary payer.

United Concordia Companies, Inc.

The organization responsible for the administration of the TRICARE Dental Program (TDP).

TDP Orthodontic Age Limit (Children)

Orthodontic treatment for eligible children is covered up to age $21$, or up to age $23$ if they are enrolled as full-time students.

TDP Orthodontic Age Limit (Spouses)

Orthodontic treatment for eligible spouses is covered up to age $23$.

Active Duty Dental Program (ADDP)

The program that handles civilian dental care for Active Duty Service Members (ADSMs) when care at a military dental clinic is not possible.

Childbirth and Breastfeeding Support Demonstration

A part of expanded maternity coverage that includes support from specific doulas and lactation specialists.

Home Birth Coverage

Deliveries planned at home are covered by TRICARE stateside in the U.S. only and are explicitly not covered in overseas locations.

TRICARE Prime Maternity Costs

Active duty service members and active duty family members (ADFMs) enrolled in this plan have $0$ out-of-pocket costs for covered maternity services.

Individual Psychotherapy Limits

Standard sessions are covered for up to $60\,\text{minutes}$, while crisis sessions are covered for up to $120\,\text{minutes}$.

Family/Conjoint Psychotherapy Limits

Standard sessions are covered for up to $90\,\text{minutes}$, while crisis sessions are covered for up to $180\,\text{minutes}$.

Group Psychotherapy Limits

Sessions are covered by TRICARE for a duration of up to $90\,\text{minutes}$.

Marriage Counseling (Coverage Criteria)

TRICARE only covers this service when it is determined to be medically necessary for the treatment of a diagnosed mental disorder.

Psychological Testing Exclusions

Testing is NOT covered for academic placement, job placement, or child custody disputes.

Substance Use Disorder (SUD) Covered Treatments

Includes detoxification, Intensive Outpatient Programs (IOP), Partial Hospitalization Programs (PHP), and Medication-Assisted Treatment (MAT).

SUD Treatment Exclusions

Specifically excluded services include aversion therapy and any unproven treatments.

Prior Authorization Requirements

Mandatory for all inpatient mental health services, including acute care, SUD treatment, rehabilitation, and residential treatment facility admissions.