FALLS CHURCH, Va. –
Are you a
member of the National Guard or Reserve? If so, it’s important to know how
TRICARE covers you if you become sick or are injured while activated for 30 days or less.
“TRICARE covers National Guard and Reserve members injured while in qualified duty status (under 30 days) through line of duty care,” said James Whitton, Chief, Military Medical Support Office at the Defense Health Agency. “LOD care covers treatment of an injury, illness, or disease incurred or aggravated in the line of duty if a LOD determination is approved.”
This article explores how, where, and under what circumstances National Guard and Reserve members can get LOD care.
How Does LOD care work?
If a National Guard or Reserve member is injured or becomes ill while on qualified duty status for 30 days or less, treatment may qualify under
LOD care. This includes injury, illness, or disease that’s incurred or aggravated while on qualified duty status.
To qualify for LOD care, the injury or illness must be military-service related. LOD may also include injury or illness while traveling to or from a duty station.
What should you keep in mind?
- TRICARE limits LOD treatment for a specific condition to one year from the date of your diagnosis. If you still need care after one year, you may be referred to the Integrated Disability Evaluation System.
- If you have any non-service related or preexisting health conditions, they won’t be covered under LOD care unless documentation indicates that the condition was aggravated as result of military-related duty.
- LOD care isn’t a government lifetime health plan.
- LOD care isn’t available to family members.
Where can I get LOD care?
LOD care is available both in the U.S. and overseas. The process for getting LOD care depends on where you live.
In the U.S.:
Overseas:
What happens once you get an authorization for LOD care? You can get care one of two ways:
- If you live within 50 miles or one hour’s drive time of a military hospital or clinic, you must get your treatment there.
- If you live remotely—more than 50 miles or one hour’s drive time from a military hospital or clinic—the MMSO will provide an authorization to the regional contractor so you can get care from a civilian provider. This includes care for both physical and mental health conditions.
These options apply in both the U.S. and overseas. However, if you’re a Reserve Component member stationed overseas:
- MMSO doesn’t validate LOD status for you, except in the U.S. Virgin Islands.
- The TRICARE Overseas contractor can authorize your remote care from a host nation provider. They can also help you book your appointment.
Do you need emergency care or urgent care?
If you reasonably believe you have an emergency, always call 911 or your international emergency number. Or, go to the nearest emergency room. If you need urgent care, go to an appropriate urgent care facility. It’s important to know that emergency or urgent care isn’t a “one-off." You need to meet LOD criteria, so you can get LOD urgent or emergency care without paying out of pocket.
Other tips for getting LOD care
Are you wondering what you need to get care? You’ll need to show proof of drill status, such as a muster form or Inactive Duty Training orders. This helps ensure a smooth LOD determination.
You’ll also need to ask your unit to submit DHA–GL Worksheet-01: Medical Eligibility Verification along with a unit sign-in sheet, muster form, or a copy of certified orders. Your submission must also include the urgent or emergency care medical notes. Your service unit must send this information to the MMSO as soon as possible after you get care.
Important: If you’re getting care under a LOD determination, do NOT use personal health insurance.
How do I submit LOD claims and view authorizations?
As detailed in the
TRICARE Choices for National Guard and Reserve Handbook, your service Military Medical Authority determines your LOD status. However, you’ll submit claims to your
regional contractor. Be sure to sign up to access your regional contractor’s secure beneficiary portal:
For other issues, such as primary eligibility in the Defense Eligibility Enrollment Reporting System or incorrect claims processing, contact the MMSO or your military hospital or clinic:
What about LOD dental care and pharmacy coverage?
What happens if you have a dental injury or illness while you’re activated for 30 days or less? You may qualify for
LOD dental care. Be sure to have your service complete an LOD determination. Your commander or designated representative must sign the determination. Send it by email or mail to the dental contractor,
United Concordia.
United Concordia will tell you if you’re approved and what type of treatment you’re approved for. Do you need more information? Call United Concordia:
- CONUS: 866-984-2337
- OCONUS: 844-653-4058
If your provider prescribes LOD-related drug for your LOD-related injury or illness, you can fill your prescription at a:
You won’t have any out-of-pocket expenses if you get your prescription at a military pharmacy. But you will pay upfront at a TRICARE retail network pharmacy and file a claim for reimbursement. Do you have questions about or need help filing for reimbursement? You can find detailed instructions, or call the MMSO at 888-MHS-MMSO (888-647-6676), option 2.
Are you seeking additional information about LOD care? Check out Line of Duty Care for Service Members or call your regional contractor. You can also learn more at Line of Duty Care.
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