Beneficiary Rights and Responsibilities
TRICARE Beneficiaries Have the Right to:
Get information – Beneficiaries have the right to receive accurate, easy-to-understand information from written materials, presentations and TRICARE representatives to help them make informed decisions about TRICARE programs, medical professionals and facilities.
Choose providers and plans – Beneficiaries have the right to a choice of health care providers that is sufficient to ensure access to appropriate, high-quality health care.
Emergency care – Beneficiaries have the right to access emergency health care services when and where the need arises.
Participate in treatment – Beneficiaries have the right to receive and review information about the diagnosis, treatment and progress of their condition, and to fully participate in all decisions related to their health care, or to be represented by family members, conservators or other duly appointed representatives.
Respect and nondiscrimination – Beneficiaries have the right to receive considerate, respectful care from all members of the health care system without discrimination based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.
Confidentiality of health information – Beneficiaries have the right to communicate with health care providers in confidence and to have the confidentiality of their health care information protected as required by law. They also have the right to review, copy and request amendments to their medical records.
Complaints and appeals – Beneficiaries have the right to a fair and efficient process for resolving differences with their health plans, health care providers and the institutions that serve them.
For more information about beneficiary rights, visit www.tricare.mil/rights.
TRICARE Beneficiaries Have the Responsibility to:
Maximize health – Beneficiaries have the responsibility to maximize healthy habits, such as exercising, not smoking and maintaining a healthy diet.
Make smart health care decisions – Beneficiaries have the responsibility to be involved in health care decisions, which means working with providers to develop and carry out agreed-upon treatment plans, disclosing relevant information and clearly communicating wants and needs.
Be knowledgeable about TRICARE – Beneficiaries have the responsibility to be knowledgeable about TRICARE coverage and program options.
TRICARE beneficiaries also have the responsibility to:
- Show respect for other patients and health care workers.
- Make a good-faith effort to meet financial obligations.
- Use the disputed claims process when there is a disagreement.
- Report wrongdoing and fraud to appropriate resources or legal authorities.
- Pay copayments, cost-shares and deductibles.
- Pay for non-covered services (if the beneficiary agreed in advance and in writing to pay for the non-covered services).
- Pay all charges if ineligible for TRICARE at the time of service.
Active duty family members enrolled in TRICARE Prime or TRICARE Prime Remote do not have copayments, cost-shares or deductibles, except for:
- pharmacy copayments
- Point of Service cost-shares and deductibles
- Extended Care Health Option (ECHO) cost-shares
TRICARE beneficiaries cannot be billed for the following charges:
- the difference between the billed amount and negotiated rate
- denied claims
- claims requiring adjustments
- claims not yet processed
- amounts above the diagnosis-related group (DRG) reimbursement schedule for DRG hospitals
- amounts in excess of the negotiated or contracted per diem