Rights and Responsibilities
Do you know your rights and responsibilities? As a TRICARE beneficiary, you have rights concerning your health care. You also have responsibilities that you should follow.
As a patient in the Military Health System, you have a right to:
- Accurate, easily understood information so you can make informed decisions about your TRICARE health plan, providers, and facilities.
- A choice of health care providers that ensures your access to high-quality health care.
- Emergency health care services when and where you need it. Coverage of emergency services is available without authorization if you have reason to believe your life is in danger or you would be seriously injured or disabled without immediate care.
- Understand your diagnosis, treatment, or prognosis, as explained by your provider.
- Fully participate in all decisions about your care. If you can't make your own decisions, you have the right to be represented by someone else. This could be a family member or conservator.
- Considerate, respectful care from all members of the health care system. You're protected against discrimination based on:
- National origin
- Mental or physical disability
- Sexual orientation
- Genetic information
- Source of payment
- Communicate confidentially with your health care team and to have your confidential information protected by law.
- Review, copy, and request amendments to your medical records.
- A fair and efficient process for resolving differences with your health plan, health care providers, and the institutions that serve them.
As a patient in the Military Health System, you have a responsibility to:
- Maximize healthy habits. You should exercise, avoid smoking, and maintain a healthy diet.
- Be involved in health care decisions. You should work with your providers to develop and carry out treatment plans, share relevant information, and clearly communicate your wants and needs.
- Learn about TRICARE health plans and coverage. This includes learning:
- Qualifications for different TRICARE health plans and your costs with each plan
- Enrollment rules, including for TRICARE Open Season and Qualifying Life Events, like a birth, adoption, marriage, divorce, and death
- Covered benefits as well as limitations and exclusions
- Rules regarding use of TRICARE network providers and non-network TRICARE-authorized providers
- Referral and authorization rules
- Appeals, claims, and grievanceYou can file a grievance when:
- You have a complaint about the quality of care you received,
- A provider or facility behaved inappropriately, or
- You have any other non-appealable issue.
The grievance may be against any member of your health care team. This includes your TRICARE doctor, your contractor, or a subcontractor. processes
- Be respectful of health care workers and others.
- Make a good-faith effort to meet your financial obligations:
- Follow the claims process. Use the disputed claims process when you have a disagreement about your claims.
- Pay your applicable deductibles and cost sharing to your provider, hospital, pharmacy, or supplier.
- Disclose any other health insuranceHealth insurance you have in addition to TRICARE, such as Medicare or an employer-sponsored health insurance. TRICARE supplements don’t qualify as "other health insurance." you may have to each provider, hospital, pharmacy, or supplier who takes care of you.
- Follow the rules of your other health insurance. This includes referral and authorization rules.
- Cancel any appointment you can't make.
- You should report any suspicion of wrongdoing, fraud, or abuse to the appropriate resources or legal authorities. >>Learn more.
Last Updated 6/29/2023