ADFMs lose TRICARE eligibility at midnight on the day the active duty sponsor is separated from service, unless they are eligible for other TRICARE coverage, TAMP, Continued Health Care Benefit Program (CHCBP) coverage, or the sponsor is transitioning to retired status. Refer to the TRICARE Program Options section of this handbook for more information.

ADSMs are required to be enrolled in TRICARE Prime; however, TRICARE Prime enrollment is not the criteria for treating an ADSM. ADSMs get care at military treatment facilities (MTFs). If civilian network care is required, the MTF will provide a referral. The Military Medical Support Office will coordinate care in certain circumstances. Once the provider verifies an ADSM’s TRICARE eligibility, the provider may deliver care and submit the claim to Humana Military for payment. The ADSM’s service branch may help coordinate ADSM care and is responsible for paying for any civilian emergency or referred health care required by ADSMs. ADSM claims should be mailed to Humana Military for processing. See the Claims Processing and Billing Information section of this handbook for additional details.

National Guard and Reserve members seeking medical care for line-of-duty injuries may appear as ineligible in DEERS if they are activated for 30 or fewer days. Refer to “Line-of-Duty Care for National Guard and Reserve Members” in the TRICARE Program Options section of this handbook for more information.