Catastrophic Cap Credit for Some TRICARE Households

4/22/2020

Since Jan. 1, 2018, enrollment fees for TRICARE Prime, TRICARE Select, and the US Family Health Plan (USFHP) haven’t been applied to the annual TRICARE family catastrophic cap for certain households. The Defense Health Agency is working to fix this issue. This issue only affects those TRICARE-eligible households who exceeded or came close to exceeding their catastrophic cap in 2018, 2019, and 2020.

What is the catastrophic cap?

The catastrophic cap is the maximum you and your family pay for covered TRICARE health care services each calendar year. This protects you because it limits the amount of out-of-pocket expenses you pay for TRICARE covered medical services. Out-of-pocket costs that apply to the catastrophic cap include:

  • Enrollment fees

  • Deductibles

  • Copayments

  • Cost-shares

How do I know if this affects me?

This may affect your household if you exceeded or came close to exceeding your family’s annual catastrophic cap in 2018, 2019, or 2020, and you paid enrollment fees in any of those years as either a:

  • TRICARE Prime Group A enrollee or TRICARE Prime Group B enrollee.

  • TRICARE Select Group BIf you or your sponsor’s initial enlistment or appointment occurs on or after January 1, 2018, are in Group B. DS enrollee.

If this affects your household, you’ll get a letter from your TRICARE regional contractor, USFHP provider, or TRICARE Overseas Program (TOP) contractor. The Department of Defense estimates this may affect about 35,000 retiree households.

What do I do if I get a letter?

If a catastrophic cap overpayment occurred, you have two options:

  • Automatically get a credit toward future enrollment fee payments.
    If you choose this option, you don’t need to do anything. You’ll be credited up to two years’ worth of enrollment fees. You’ll get a refund for any amount over two years’ worth.

  • Request a refund of the amount overage.
    You may also request a refund for the overage amount. Make this refund request by calling your regional contractor, USFHP provider, or TOP contractor.

Going forward, future enrollment fees will be credited towards your family’s yearly catastrophic cap. To learn more about your catastrophic cap or TRICARE costs, visit Cost Terms and Costs on the TRICARE website.


Last Updated 6/23/2020