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Line of Duty Care for National Guard and Reserve Members

6/28/2013

Understanding TRICARE health care options for National Guard and Reserve members can be confusing as it varies based on their duty status. When a member suffers or aggravates an injury, illness or disease while in a qualifying duty status, they may be eligible to receive care at the government’s expense.

When activated for more than 30 days, Guard and Reserve members are eligible for TRICARE Prime. If a Guard or Reserve member gets injured or aggravates an existing injury or illness as a direct result of his or her duties during a period of activation less than 30 days, that Guard or Reserve member may be covered under line of duty (LOD) care or notice of eligibility (NOE) care for members of the Coast Guard. Weekend drill, summer training exercises and/or national disaster response are examples of activations for less than 30 days. For care received from a civilian provider, the Military Medical Support Office (MMSO) reviews the LOD/NOE case. For care received at a military hospital or clinic, the facility where care is received reviews the LOD/NOE case.

For emergency room visits, prior authorization is not needed. However, if the service member is admitted to a hospital or if additional care is needed, he or she must get authorization from the MMSO or the military hospital or clinic, preferably before admission, or as soon as possible after admission. For ongoing care, service members who live or work near a military hospital or clinic Prime Service Area should seek LOD/NOE care from that facility. For those who do not, the service member’s command or medical unit requests an authorization for civilian medical care by submitting and LOD/NOE determination to the MMSO.

To continue receiving LOD/NOE care once the period of activation ends, service members must stay in the Guard or Reserve, continue to need treatment, and care must be authorized. Guard and Reserve members should make sure their command or medical unit has a copy of the LOD/NOE document before being released from active service. Prescription medications must be paid for out-of-pocket, but members can file a claim for reimbursement.

Guard and Reserve members activated less than 30 days do not show as TRICARE-eligible in the Defense Eligibility Enrollment Reporting System (DEERS). Because of this, it is extremely important all paperwork and documentation is complete –  like the LOD/NOE document and active service orders – when seeking treatment. For more information on LOD/NOE care or to download the TRICARE Treatment of Line of Duty Conditions Fact Sheet, please visit www.tricare.mil/LOD.

Last Updated 9/3/2014