In most cases, your provider will file your medical claims for you and you'll receive an explanation of benefits detailing what was paid. Sometimes, you'll need to file your own claims (i.e. when traveling or getting care from a non-participating provider).
If you do, you should send your claim form to TRICARE as soon as possible after you receive care. The sooner your claim and other paperwork are received, the sooner you or your provider will be paid.
- In the U.S. and U.S. territories, claims must be filed within one year of service.
- In all other overseas areas, claims must be filed within three years of service.
When you file a claim, you will be reimbursed for TRICARE-covered services at the TRICARE allowable amount. This amount will not include any copayments, cost shares or deductibles.
There are special rules for filing claims if you're involved in an accident with possible third-party liability.
Claims for Same-Sex Spouses
Once your spouse shows as eligible for benefits in the Defense Enrollment Eligibility Reporting System (DEERS), he or she can file claims for care received:
- On or after June 26, 2013—if married before June 26, 2013, or
- Back to the date of eligibility in DEERS—if married after June 26, 2013.