In most cases, your provider will file your medical claims for you. You'll receive an explanation of benefits detailing what TRICARE 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, you must file your claims within one year of service.
- In all other overseas areas, you must file your claims within three years of service.
There are many different types of claims you can file:
The sooner TRICARE gets your claim and other paperwork, the sooner you or your provider will be paid. TRICARE claims processors process most claims within 30 days. Check with your claims processor for more information.
- TRICARE will reimburse you 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 within 24 hours, so your provider can confer with the attending doctor. This is either the 800 number or your primary care provider’s phone number.
TRICARE will cover your costs for everything above your copaymentA 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 it is the nearest emergency facility to you when you become ill or injured.
Once your spouse shows as eligible for benefits in the Defense Enrollment Eligibility Reporting System(DEERS) A database of information on uniformed services members (sponsors), U.S.-sponsored foreign military, DoD and uniformed services civilians, other personnel as directed by the DoD, and their family members. You need to register in DEERS to get TRICARE. (DEERS), they can file claims for the care they received.
- If you were married before June 26, 2013, you can file claims for any care that you received on that date or after.
- If you were married after June 26, 2013, you can file a claim for any care that you received starting at the date of your eligibility as listed in DEERS.
Last Updated 3/23/2021