Tricare is the health insurance program that provides coverage to active duty military service members, retirees, reservists, National Guard members, and their spouses, dependents, and survivors. Tricare combines military medical services with a network of civilian health care facilities and providers. Filing claims with Tricare depends on your personal status, location, and which plan you are a part of.
Ordinarily, Tricare claims are filed on your behalf by the provider you are visiting. In certain circumstances, you may need to file a Tricare claim yourself. Tricare payments will be processed at the allowable amount less any required co-payments or deductibles. You must file within one year of the date of service.
Download and complete the “Patient’s Request for Medical Payment – DD Form 2642.” Attach a legible copy of the provider bill for services, making sure it includes the sponsor’s social security number, the provider’s name and address, the dates, descriptions, and charges for all services received, and the diagnosis.
Make sure that your enrollment in the Defense Enrollment Eligibility Reporting System (DEERS) is up to date. If your information is not current, your Tricare claim may be denied until it is corrected.
Verify that all twelve sections of the form are completed and remember to sign the form. Keep a copy of the paperwork for your records. Mail the paperwork to the appropriate claim address as listed on the Tricare website. File only one claim at a time in order to avoid confusion.
It’s important to file your claim with any other health insurance company you have first, since Tricare is normally the secondary insurer if you have other coverage. Once you have received the explanation of benefits from the other insurer, you can include a copy with your Tricare claim.
If you are injured in an accident and there is a possibility that a third party has liability in the situation, you must file the “Statement of Personal Injury-Possible Third Party Liability – DD Form 2527.” If Tricare sees something on your claim that causes them to believe there may be third party liability, they will send you the form to complete and your claim will be suspended until the form is submitted.
Once your claim has been processed, you will receive an explanation of benefits detailing what was paid and how it was applied to your medical expenses. You do not need to do anything with this form, but it is for your information and it’s a good idea to keep it on file.
If you have further questions or need other information, visit the Tricare website for full details. You can also find a list of toll-free numbers on the site if you prefer to contact Tricare by phone.