Tricare Catastrophic Cap Resets

On Oct. 1, the Tricare catastrophic cap began anew for fiscal 2007. The cap limits out-of-pocket Tricare expenses to $1,000 for active duty individuals and families and $3,000 for all other Tricare beneficiaries during each fiscal year running from Oct. 1 through Sep. 30. It applies to all Tricare services, including deductibles, pharmacy copays, enrollment fees and other cost shares. Once a family reaches the cap, Tricare will pay the family’s share of all Tricare expenses for the remainder of that fiscal year. The cap applies only to Tricare services and not to nonparticipating providers who may charge more than Tricare maximum allowable charges. It also does not apply to expenses paid under the Prime point-of-service plan.