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Beneficiary

    How do I file a complaint (grievance)?

    You can submit a grievance by mail or fax. Learn more on our Grievances page.

    How do I file an appeal?

    Appeals can be submitted online, by mail or fax. Learn more about what types of authorizations and claims can be appealed and who can file an appeal on our authorization appeals and claims appeals pages.

    What is the pharmacy benefit?

    Learn more about the pharmacy benefit on the TRICARE Pharmacy Program page.

    What is the dental benefit?

    Dental care is not covered under the medical plan except authorized adjunctive dental. Learn more about the dental benefit on TRICARE's My Dental Coverage page.

    What are the costs for mental health services?

    The cost for mental health services varies depending on the type of service. Visit TRICARE's Mental Health Costs page to learn more.

    What is the ECHO program?

    The Extended Care Health Option (ECHO) program is available to active duty family members with special needs. This program provides services and supplies beyond the basic TRICARE military health care program. Learn more about it on the ECHO page.

    How do I get a case manager?

    You or your provider can request a case manager. Learn more about this program and how to request a case manager on our case management page.

    What is the Warrior Care Support Program?

    The Health Net Federal Services Warrior Care Support Program provides complete health care planning and coordination services for Warriors who have been severely injured or have a combat related mental health diagnosis and their families. Learn more on our Warrior Care Support Program page.

    Does TRICARE cover school physicals?

    School enrollment physicals for ages 5–11 years are covered. Learn more about coverage on TRICARE's See What's Covered page.

    How can I request a second opinion?

    Depending on your TRICARE plan type, an approval from Health Net Federal Services, LLC may be required for a second opinion. Learn more on our Second Opinion page.

    Are breast pumps and supplies a covered benefit?

    Breast pumps, supplies and breastfeeding counseling are covered TRICARE benefits. Visit TRICARE’s Breast Pumps, Breast Pump Supplies and Breastfeeding Counseling Frequently Asked Questions to learn more. Visit our Breast Pump Reimbursement page to learn about getting reimbursed for your purchase.

    How do I check claims status?

    You can check the status of your claim online

    Why was my claim denied?

    The Explanation of Benefits (EOB) will provide details as to why your claim was denied. You can view your EOB online (log in required).

    How does TRICARE work with other health insurance?

    Learn more about how TRICARE works with your other health insurance on our other health insurance page.

    How do I submit a claim?

    Most providers will submit claims on your behalf. TRICARE network providers are required to submit claims; however, TRICARE non-network providers may require you to submit the claim. All outpatient claims must be filed no later than one year after the services are provided. Inpatient care claims must be filed one year from the date of discharge. See our Submit a Beneficiary Claim page for more information.

    How do I update my other health insurance?

    You can update your other health insurance information with TRICARE online (log in required) or you may complete and submit the TRICARE Other Health Insurance Questionnaire. Updates submitted through the website will be processed in three business days. Updates submitted through the questionnaire will be processed in 30 business days.

    What is a claims recoupment?

    When a payment error is discovered during the claims review process, Health Net Federal Services, LLC is required to process a correction and recover any funds paid in error (recoupment). In certain cases, a recoupment letter is sent requesting a refund. If you receive a claims recoupment letter, follow the instructions as provided. Please note cash payments are not accepted. All recoupment payments must be made by check or money order.

    How can I access my explanation of benefits (EOB)?

    TRICARE requires beneficiaries access individual Explanation of Benefits (EOBs) online. To do this, log in and click on “Summary TEOB.” If you would like paper copies of claim information, you can call customer service to request individual EOBs on a per-instance basis. You can also request ongoing monthly summary EOBs be sent to by mail.

    When will my enrollment be effective?

    The effective date for your enrollment depends on your TRICARE plan option. Learn more on your plan's enrollment page.

     

    How do I add my newborn or adopted child?

    It's important to register your newborn or adopted child in the Defense Enrollment Eligibility Reporting System (DEERS) and enroll him/her into a TRICARE plan within 90 days of the qualifying life event (QLE).

    Visit your plan's enrollment page to learn how to add a newborn or adopted child.

     

    How do I change my primary care manager?

    Learn more on our changing your PCM page.

     

    Is my college student covered?

    Dependent children are eligible for TRICARE up to the age of 21 or up to the age of 23 if the child is a college student enrolled full-time at an accredited institution of higher education and the sponsor provides more than 50 percent of the child's financial support.

    To ensure continuous TRICARE coverage, your child's information must be updated in the Defense Enrollment Eligibility Reporting System (DEERS) prior to the loss of eligibility. Visit a RAPIDS site for assistance regarding the documentation needed.

     

    The TRICARE Young Adult program may also be an option for your college student. Visit our TRICARE Young Adult page to learn about plan options and how to enroll.

    How do I enroll in TRICARE Prime?

    Learn more about how to enroll in TRICARE Prime on our enrolling with TRICARE Prime page.

     

    What do I do if I've moved?

    Your new address may come with different TRICARE options. Be sure to update your address with the Defense Enrollment Eligibility Reporting System (DEERS) through the milConnect website or Beneficiary Web Enrollment and the U.S. Postal Service.

    Learn more on our moving with TRICARE page.

     

    Why am I ineligible for TRICARE?

    You must be registered in the Defense Enrollment Eligibility Reporting System (DEERS) to be eligible for TRICARE. If you have a change in status or a change in your orders, make sure you update DEERS through your local RAPIDS site. Once updated, follow up with TRICARE about the potential changes to your coverage.

     

    How do I update my address?

    Log in to the milConnect website to update your address in the Defense Enrollment Eligibility Reporting System (DEERS).

     

    I am retiring. What do I do?

    When you retire from active duty, you will have new TRICARE coverage options.

    Learn more about enrolling as a retiree on our TRICARE Prime Enrollment – Retirees and Their Family Members page or TRICARE Select page.

    Note: TRICARE Prime Remote is not available for retirees and their family members. 

     

    Why do I need to go to a primary care manager at the military hospital or clinic?

    Your primary care manager (PCM) assignment is based on your home address and the military hospital or clinic requirements for your area. Some military hospitals and clinics require PCM assignment for members who live within a 30-minute drive time. If your home address is within 30 minutes, and you are in an area with a military hospital or clinic that requires enrollment, your PCM assignment must be with that military hospital or clinic.

    Drive time standards:

    • Active duty service members: maximum 60-minute drive time from your home address to a military hospital or clinic
    • All other beneficiaries: maximum 30-minute drive time from your home address to a military hospital or clinic

     

    How do I add a spouse to TRICARE?

    Sponsors must register new spouses in the Defense Enrollment Eligibility Reporting System for them to be eligible for TRICARE. To register a spouse in DEERS, visit a RAPIDS site to do the following:

    • Provide a copy of the marriage certificate. 
    • Show two forms of ID (for example, any combination of Social Security card, driver's license, birth certificate, current military ID card or Common Access Card [CAC]).

    Once the new spouse is registered in DEERS, he or she will receive a military ID card and will be eligible for TRICARE.

    In addition to registering your spouse in DEERS, some TRICARE programs require enrollment. Learn more your program's enrollment page.

     

    How do I get a TRICARE Wallet Card?

    View and print TRICARE Wallet Cards at the milConnect website. In addition to the Wallet Card, TRICARE beneficiaries should present their uniformed services identification (ID) card or Common Access Card (CAC) at the time of service. TRICARE For Life beneficiaries use their Medicare card along with their uniformed services ID card or CAC. 

    Note: The cards do not guarantee eligibility nor are they required to obtain care but do contain important information for beneficiaries.

     

    Is it OK for my doctor's office to photocopy my military ID card?

    Yes, it is OK for your doctor's office to copy your military ID card or Common Access Card (CAC). It is recommended that they copy both sides of the ID card or CAC to assist in eligibility verification and for the purpose of rendering care.

    A valid ID card or CAC alone is not sufficient to prove eligibility; providers must verify eligibility.

     

    Why did my PCM change?

    Although Health Net Federal Services, LLC (HNFS) makes every effort to ensure you remain with your requested primary care manager (PCM), there are situations beyond our control that may result in an unsolicited change. Some of those reasons are:

    • Access to care: If your residence is over 30 minutes from your PCM’s office, or you live in an area where TRICARE Prime is not offered, you must sign the drive time waiver (DTW) agreeing to travel in order to receive care. If a DTW is needed but not received, HNFS will notify you by letter. If no response is received, we are required to make necessary changes to your PCM assignment in order to ensure you meet program requirements.

    • Military hospital and clinic recaptures: Individual military hospitals and clinics decide who is required to receive care at their locations. A military hospital or clinic may decide to have beneficiaries reassigned to a PCM on base at any given time. You are notified of any upcoming changes via mail, email or phone call, and may be given an opportunity to remain with your current provider, at the military hospital or clinic's discretion.

    • Provider contract termination: If your PCM’s contract terminates or expires, HNFS is required to move you to an alternative PCM. These changes are made in accordance with the military hospital and clinic's guidelines; if you are within 30 minutes of a mandatory military hospital or clinic, your new PCM may be located on post.

     

    What is Transitional Care for Service-Related Conditions?

    The Transitional Care for Service-Related Conditions (TCSRC) program extends the period of TRICARE eligibility for service-related conditions up to 180 days from enrollment into the TCSRC program. Learn more on our TCSRC page.

     

    How do I locate a provider in the TRICARE West Region or in another TRICARE region?

    Below is a list of regions and the states that are included. Be sure you are following your plan option rules for authorization and referral requirements when seeking care.

    West Region
    To locate providers in the TRICARE West Region, use our Provider Directory.

    States included in the West Region: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (except the Rock Island Arsenal area), Kansas, Minnesota, Missouri (except the St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (the western region including Amarillo, Lubbock and El Paso), Utah, Washington, and Wyoming.

    East Region
    The contractor for the East Region is Humana Military. You can locate providers in the states below using Humana Military's provider locator.

    States included in the East Region: Alabama, Arkansas, Connecticut, Delaware, the District of Columbia, Florida, Georgia, Illinois, Indiana, Kentucky (except Ft Campbell), 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, a major portion of Texas (except for the extreme southwestern El Paso area), Vermont, Virginia, West Virginia and Wisconsin.

    How do I locate a military hospital or clinic?

    Locate a military hospital or clinic using TRICARE's Military Hospital or Clinic Locator.

    How do I locate a pharmacy?

    Visit TRICARE's Prescriptions page to locate a military treatment facility pharmacy and learn more about the pharmacy benefit.

    In addition you can visit Express Scripts to find a local retail pharmacy or switch to TRICARE Pharmacy Home Delivery.

    How do I locate a dentist?

    Learn more about the dental benefit on TRICARE's My Dental Coverage page. Find your beneficiary category and click on the link to your dental plan. This page provides a summary of your dental benefits and includes a link to locate dental providers.

    What is the difference between a network and non-network provider?

    A network provider is a civilian provider who has completed the credentialing process and signed a contracted agreement to be part of the network of providers who participate in the TRICARE program. A network provider accepts the negotiated rate as payment in full for services rendered.

    A non-network provider is a civilian provider who is authorized to provide care to TRICARE beneficiaries, but has not signed a network agreement. Non-network providers meet TRICARE licensing and certification requirements, and are certified by TRICARE to provide care to TRICARE beneficiaries. There are two types of non-network providers – participating and nonparticipating.

    • Nonparticipating Provider: An authorized hospital, institutional provider, physician, or other provider that furnishes medical services (or supplies) to TRICARE beneficiaries, but has not signed an agreement and does not agree to accept assignment. A nonparticipating provider may balance bill up to 115 percent of the TRICARE allowable charge.
    • Participating Provider: Providers who participate in TRICARE or accept assignment agree to file claims for TRICARE beneficiaries, accept payment directly from TRICARE and accept the TRICARE-allowable charge as payment in full for their services. Non-network individual providers may participate on a case-by-case basis. Providers must seek applicable copayments, cost-shares and deductibles from the beneficiary. Hospitals that participate in Medicare must, by law, also participate in TRICARE for inpatient care. For outpatient care, they may or may not participate.

    What is the difference between a prior authorization and referral?

    Learn more about the differences on our Prior Authorizations and Referrals page.

    How do I request a new prior authorization or referral?

    TRICARE requires a provider, typically your primary care manager or family doctor, to submit prior authorization and referral requests. Please contact your provider and have him or her submit your request. 

    Why was I referred to a military hospital or clinic for care?

    If you are a TRICARE Prime beneficiary living near a military hospital or clinic and are referred for specialty care, inpatient admissions or procedures requiring approval, Health Net Federal Services, LLC will first attempt to coordinate your care at the military facility. If the services are not available at the military hospital or clinic, the care will be coordinated with a TRICARE network provider.

    Visit our Referrals to Military Hospitals and Clinics page for additional information.

    How can I get prepared for my next doctor's appointment?

    It's important to prepare for your next doctor's appointment so you can get the most out of your time with him or her. We have created some appointment tips which include a checklist of the things you might want to ask your doctor and the things that are important for him or her to know.

    What if my referral or prior authorization was denied?

    Any denied authorization can be appealed. However, the following cannot be appealed:

    • Authorizations approved under point of service.
    • Authorizations redirected and approved to a network provider when a non-network provider was requested.
    • Authorizations redirected and approved to a military treatment facility.

    Learn how to file an appeal on our Authorization Appeals page.

    Do I need a prior authorization or referral even though I have other health insurance?

    Active duty service members who have other health insurance (OHI) require an approval from Health Net Federal Services for all services. All other beneficiaries with OHI only require a prior authorization for applied behavior analysis services. Beneficiaries with OHI need to follow their OHI rules for obtaining care even if those services are not covered by OHI or benefits have been exhausted.

    Visit our How TRICARE Works with OHI page to learn more. 

    Do I need an authorization for a breast pump?

    An approval from Health Net Federal Services, LLC is not required for breast pumps or supplies, as long as the breast pump obtained matches the type of pump included on your prescription from a TRICARE network or non-network physician, physician assistant, nurse practitioner, or nurse midwife.

    Using a network provider will prevent you from having to pay for services up front and filing claims for reimbursement later.  

    View TRICARE’s Breast Pump and Supplies benefit page for more information on what’s covered.

    What is SHCP?

    Supplemental Healt Care Option (SHCP) is a program for eligible uniformed service members who require medical care that is not available at the military hospital or clinic and must be referred to a civilian provider. The SHCP is also available on a limited basis for non-TRICARE eligible individuals when specifically referred by the military hospital or clinic.

    Learn more about SHCP by visiting our Supplemental Health Care Program page.

    How do I make a change to my prior authorization or referral request? 

    Use the Check Authorization Status tool to change the provider to another network provider of the same specialty (some exceptions apply). For additional changes, your provider can send us a request online.

    How can I access my authorization letter?

    TRICARE requires beneficiaries access referral and authorization determination letters online. To do this, log in and click on “Secure Inbox.”  If you do not have access to a computer, you can call customer service to request letters be mailed to you on a per-instance basis. You must do this each time you want a letter mailed, as beneficiaries cannot opt out from receiving electronic referral and authorization notifications. 

    How do I get copies of medical records?

    Military hospital/clinic records
    To obtain copies of your medical records, contact the records department at the military hospital/clinic where your medical records are located.

    Civilian records
    To obtain copies of your medical records, contact your provider's office directly. Some providers may require your new doctor's office to request your medical records. Non-active duty service members may be charged a processing fee for copying your records.

    How do I get medical information about a family member or release information to a family member?

    Protected health information (PHI) can only be released to those individuals who have been granted access within the account registration on www.tricare-west.com, on legal documentation or an Authorization to Disclose Medical Information form.

    Adult family members can grant permission to another family member when registering at www.tricare-west.com. This is the fastest way to record this permission. The Authorization to Disclose Medical Information form can also be used and must be completed by the beneficiary who chooses to allow access to his or her information. Submit the completed form to the address or fax number located on the bottom of the form. Allow 7–10 business days after receipt of this form for processing.

    How long will it take for my authorization or referral to be approved?

    Health Net Federal Services processes routine requests within 2–5 business days and urgent requests in an expedited manner using the clinical information provided by your health care provider.

    We fax determination letters for routine and urgent requests directly to the provider. Beneficiaries can opt to receive email or text notifications once we've processed an authorization or referrals. To sign up for email or text messages, log in to www.tricare-west.com with your DoD Self-Service Logon and edit your account settings.

    Check the status of your authorization or referral on our Check Status page. 

    What if I need to be seen today?

    TRICARE Prime active duty service members must first contact their primary care manager (PCM). If you cannot get care from your PCM, he or she must submit a referral to HNFS for civilian urgent care services. All other TRICARE beneficiaries do not require a referral for urgent care. Learn more on our urgent care page.

    How do I change the doctor on my referral?

    Some provider changes can be made using our Check Authorization and Referral Status tool. Use the tool to check your authorization/referral status and make provider changes.

    You can also contact HNFS so we can review if a provider change is possible. 

    There are times when a provider change cannot be made. For example, a TRICARE Prime beneficiary is required to seek services from a military hospital or clinic, or a network provider when one is available within the access standards. Please note, the determination to refer you to a network provider when one is available is not an appealable issue. If you choose to see a non-network provider when you've been directed to a network provider, you will use your Point of Service option.

    Use our Network Provider Directory to search for network providers in your area.

    What are TRICARE's access standards?

    TRICARE Prime beneficiaries are guaranteed certain access standards for care regarding wait time to be seen and drive time to a health care facility. See the access standards page for timeframes.

    How do I make an appointment?

    You can make an appointment at a military hospital or clinic through the TRICARE online website, or you may call the military hospital or clinic or civilian provider directly to make an appointment. View the access standards for appointment timeframes regarding how quickly you can expect to be seen by your provider.

    If I'm going to miss my appointment, why is it important I call to cancel?

    If you are going to miss your appointment, it is important you contact the provider to cancel or reschedule because some providers charge a missed appointment fee which is not covered by TRICARE.

    In addition to avoiding unnecessary fees, notifying your provider's office ahead of time allows the office staff to offer the appointment to other patients who need to see the doctor, but have been placed on a waiting list.

    There are no fees involved with missed appointments at a military hospital or clinic. However, it is recommended you call at least one day in advance to cancel your appointment.

    What is a convenient care clinic?

    A convenient care clinic (CCC) is a health care facility located in a high-traffic, retail-based location (for example, CVS, Kroger, Walgreens, etc). They are usually open seven days a week with extended hours. Appointments are not required as patients are seen on a walk-in basis.

    A CCC is typically staffed by nurse practitioners or physician assistants and provides limited services, such as vaccinations and treatment of minor illnesses. A CCC should not be confused with a full-service, urgent care clinic staffed by physicians.

    You can search for network CCCs using our Network Provider Directory. Beneficiaries should contact the CCC prior to seeking care to verify which services it offers.