Transitional Care for Service-Related Conditions

The Transitional Care for Service-Related Conditions (TCSRC) Program extends TRICARE coverage to former active duty, Guard, and Reserve members for certain service-related conditions beyond their regular 180-day TAMP coverage period. The benefit is available worldwide.

Eligibility

If you are eligible for care under TAMP and have a newly-diagnosed medical condition related to your active-duty service, you may qualify for an additional 180 days of care. To qualify for TCSRC, your medical condition must be:

  1. Service-related
  2. Newly discovered/diagnosed during the 180-day TAMP period
  3. Able to be resolved within 180 days
  4. Validated by a DoD physician   

Once your medical condition is validated by the DoD, DOD reflects your TCSRC coverage 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).

Benefits

If you qualify, you'll receive medical care for that condition, and that condition only. No copayments or cost shares will apply as if you are still on active duty. If you have multiple service-related conditions, each condition will have its own enrollment and coverage period.
TCSRC enrollment includes eligibility for prescriptions necessary to treat your service-related condition(s). You can fill your prescriptions through any of the pharmacy options: military, network, non-network pharmacy, or via home delivery. If you’re near a military pharmacy, you may want to get your prescriptions filled there. If not, home delivery is your next best option.

If you use a network or non-network pharmacy during the TCSRC benefit period, you may experience out-of-pocket cost, but you can file a prescription claim. Be sure to send a copy of your TCSRC approval letter with your form. TRICARE will fully reimburse you for medications related to your TCSRC-authorized condition. TCSRC will not cover the cost of medications unrelated to the treatment of a TCSRC-authorized condition.

Enrollment into this program doesn’t affect your eligibility for any other TRICARE program for you and your family members. (i.e. Deactivated Guard/Reserve members in the Selected Reserve may enroll in TRICARE Reserve Select and use TCSRC benefits for qualified service-related conditions.)

Getting Started

To see if you qualify for the TCSRC Program, follow these simple steps:

  1. Prepare a letter requesting coverage under the program and indicate the condition(s) for which you are seeking extended care. Download a Sample Letter. We suggest that you validate with your unit that you show as TAMP-eligible in DEERS. 
  2. Collect copies of all documents showing the condition(s) is/are service-related (please do not send any original documents). Examples include clinical notes from your medical records or a line of duty report. TRICARE considers other documentation (i.e. medical notes, accident notes, letter/statement from Commanding Officer saying it happened on active duty, etc.) if your medical condition isn’t documented in your medical records.
  3. Download the Application Worksheet. Complete your portion of the Application Worksheet and give the Provider Checklist & Instructions to your provider to complete indicating the condition(s) is/are resolvable within 180 days. The doctor who completes the Provider Checklist should be the provider who treats your condition(s). For example, if your primary care manager refers you to a specialist for the medical condition, then the specialist should complete the Provider Checklist. See the section below about finding a provider. 
  4. Submit your letter with the completed Application Worksheet and all documentation showing the condition is service-related and can be resolved within 180 days to:

Military Medical Support Office at Defense Health Agency, Great Lakes 
ATTN: Healthcare Support Services 1637 Cell
2834 Green Bay Road, Suite 304
North Chicago, IL 60064-3091

If you have questions about qualifying for TCSRC benefits, contact the Reserve and Service Member Office at 1-888-647-6676 and follow the prompts for assistance. Once the DoD physician validates you are eligible for the TCSRC program and be sent a letter confirming your eligibility.

If you live in the United States, you'll also receive an authorization letter from your regional contractor. The authorization applies to the entire episode of care and expires 180 days after the DoD physician's date of validation.

If you live overseas, contact your TRICARE Area Office (TAO) to get specific information about your benefits and coverage. 

  • TAO Eurasia-Africa: 0049-6371-9464-2999
  • TAO Latin America & Canada: 1-210-292-8520
  • TAO Pacific: +81-98-970-9155

Finding a Provider

Any provider (military, network or non-network) can complete the Provider Checklist portion of Application Worksheet. When approved, this is most likely the same doctor who will provide the care for your medical condition during the 180-day TCSRC coverage period.

If you live near a military hospital or clinic, try to get care there. If note, we recommend you visit a network provider, if one is available. Visit your region's network provider directory, listed below, to find a network provider near you or contact your regional contractor for assistance.

If a network provider is not available, you may visit a TRICARE-authorized, non-network provider. In some cases, you may have to pay up front for care and file a claim for reimbursement. Be sure to always include a copy of your TCSRC approval letter when filing a TCSRC claim. Send your claims to your regional contractor at one of the following addresses:

East  TRICARE East Region
Claims Department
P.O. Box 7031
Camden, SC 29020-7031
West  TRICARE West Region
Claims Department
P.O. Box 7064
Camden, SC  29020-7064

Overseas Providers

If a military hospital or clinic is not available overseas, you may visit any overseas provider. The overseas contractor, International SOS, has established a network of qualified providers in all overseas areas. For assistance finding an overseas provider:

In most cases overseas, you'll need to pay up front for the care and submit paper claims for reimbursement. Be sure to always include a copy of your approval letter when filing TCSRC claims. Send your claims to the following address from all overseas areas:

WPS - Active Duty Claims Processing
P.O. Box 7968
Madison, WI 53707-7968

If You Don't Qualify

Service-related conditions not resolved within the 180-day TCSRC period and aren’t approved for the TCSRC Program, may receive medical care for this condition through the Department of Veteran's Affairs (VA). The VA determines eligibility for VA benefits. Call 1-877-222-8387 or visit www.va.gov for more information. Additionally, if you are currently in the National Guard or Reserves, you may want to contact your unit to see if you qualify for line of duty benefits.

If you have additional information from your provider that supports his/her belief that your condition can be resolved within 180 days, you may request reconsideration of your application in writing within 30 days of the date of this letter. Supporting documentation and requests for reconsideration may be sent by fax or mail to:

Military Medical Support Office at Defense Health Agency, Great Lakes
ATTN: Healthcare Support Services 1637 Cell
2834 Green Bay Road, Suite 304
North Chicago, IL 60064-3091

Fax: 1-866-531-7881

What if I'm eligible for Medicare?

  • Medicare doesn't pay claims for active duty care.
  • The TSRC benefit provides active duty care. You must fill out all claims related to your approved service-related condition with the appropriate regional claims processor. See above for your claim address.

What if I'm enrolled in the US Family Health Plan (USFHP)?

  • Your US Family Health Plan Provider can't provide "active duty care," so they can't participate in the TCSRC Program.
  • To qualify, you must get care from a military clinic or hospital, or TRICARE-authorized providerAn authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network. DS, as described above.
  • Your USFHP Provider provides separate treatment for the care of your service-related condition.

Last Updated 6/3/2013