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:
- When traveling
- If you get care from a non-participating provider
- If you're using TRICARE For Life and you see a Medicare nonparticipating provider
If you do, send your claim form to TRICARE as soon as possible after you get care.
- 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.
The sooner your claim and other paperwork are received, the sooner you or your provider will be paid. Most claims are processed within 30 days. Please check with your claims processor for more information.
- You'll be reimbursed for TRICARE-covered services at the TRICARE allowable amount.
- This amount won't 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.
- If you need assistance at any time or if your claim is denied, contact your regional contractor.
US Family Health Plan
You won't need to file claims when using the US Family Health Plan.
If you need care when traveling:
- Go to the nearest appropriate medical facility.
- Call the US Family Health Plan (either the 800 number or your primary care provider’s phone number) within 24 hours, so your provider can confer with the attending doctor.
Your costs will be covered for everything above your copaymentClick to closeA fixed dollar amount you may pay for a covered health care service or drug..
- Show your US Family Health Plan membership ID.
- Have the bill sent to the address on the back.
You can get care for medical emergencies at a military hospital or clinic if is the nearest emergency facility to you when you become ill or injured.
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.