Line of Duty for Service Members

LOD for RC members is defined as an injury, illness or disease incurred or aggravated while in a qualified duty status (orders 30 days or less).  The incurred or aggravated condition must be military service connected.

The Military Medical Support Office at Defense Health Agency–Great Lakes or the military hospital or clinic will use the LOD determination to authorize appropriate follow-on medical care when needed after the period of the member’s orders have expired. This is for the covered condition for not longer than one year from the date of diagnosis. Those identified for referral to the Integrated Disability Evaluation System (IDES) may not qualify.

  • Only a military hospital or clinic or MMSO can direct the managed care support contractors to issue an LOD authorization to ensure LOD claims process and pay correctly.

Is LOD a government lifetime health plan? No. It’s a special eligibility status. And it’s for treatment of a specific condition for a period not to exceed one year.

How to Get Care

Register yourself on the TRICARE website in your region. Authorizations, LOD claims processing information, and Explanation of Benefits (EOB) can be found on these sites.

  • Humana Government Business (East RegionAlabama, Arkansas, Connecticut, Delaware, the District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa (Rock Island area), Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri (St. Louis area), New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas (excluding El Paso area), Vermont, Virginia, West Virginia, and Wisconsin.)
  • Health Net Federal Services (West RegionAlaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (excludes Rock Island arsenal area), Kansas, Minnesota, Missouri (except St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (southwestern corner including El Paso), Utah, Washington and Wyoming.)

Emergency/Urgent Care

Seek care at your nearest facility. Contact your unit to provide MMSO with verification “Worksheet 1” and a unit sign in sheet, muster form or orders. Your unit must submit these documents to MMSO as soon as possible after you get care. 

Care at a Military Hospital or Clinic

You must seek LOD care at a military hospital or clinic if you’re within 50 miles or one hour drive time. For initial care at the MTF, provide proof of drill status (muster form, IDT orders).  The military hospital or clinic will provide authorization for additional care as necessary. This includes any care outside of the military hospital or clinic. Contact Patient Administration or TOPA Flight (AF) for assistance with access to care at the military hospital or clinic. 

Civilian Care, also known as Remote Care

This is care outside of 50 miles or one hour drive time from the military hospital or clinic. Your unit must initiate LOD and provide documentation to the Military Medical Support Office Great Lakes (MMSO/ DHA GL).  

I’m an RC LOD Member. What Do Need to Know?

  • You must participate in your own health care. This isn’t a passive process.
  • Ensure your providers are given correct TRICARE claims address. 
  • Contact the applicable contractor if your provider isn’t filing claims. (see links above)
  • Register and use the Beneficiary Self-Service portal.
  • You should check the contractors Self-Service portal to make sure authorizations are on file. Monitor your Explanation of Benefits (EOBs) to ensure your claims are paying correctly.
  • Don’t use personal health insurance. Let the government LOD authorization and claims process work.

Claims Processing

MMSO reviews and authorizes LOD care for remotely located RC members residing > 50 miles or one hour drive from a military hospital or clinic.

Military hospitals and clinics oversee and authorize LOD care for RC members residing < or = 50 miles or one hour drive.

If a RC member has another primary eligibility in DEERS such as:

  • TRICARE Reserve Select (TRS)
  • Transition Assistance Management Program (TAMP)
  • Dependent of Active Duty SM

And has a service connected LOD condition.  Remote RC members should reach out to MMSO (or the MTF if the MTF is overseeing the LOD care) if claims don’t pay correctly. MMSO or the MTF patient administration will work with contractor to reprocess claims without cost share or deductible.

LOD/NOE is limited coverage and separate from any other TRICARE coverage. That means it is different from:

Submit your claims for line of duty medical care to your regional contractor. >>Learn More

Note to Air Force Reservists: A military hospital or clinic can verify your eligibility for LOD care. Call the Air Force Reserve Command toll-free at 1-888-577- 2561, option “3” from 7:00 am to 5:00 pm ET, Monday – Friday.

Need Line of Duty Dental Care?

MMSO doesn’t authorize LOD Dental care. Dental LOD support is available through United Concordia at 1-866-984-2337. 
The Active Duty Dental Program provides line of duty care. >>Learn More

 

Last Updated 2/16/2024