• Army National Guard
• Army Reserve
• Marine Corps Reserve
• Navy Reserve
• Air Force Reserve
• Air National Guard
• U.S. Coast Guard Reserve

Line-of-Duty Care for National Guard and Reserve Members

A line-of-duty (LOD) condition is determined by the military service and includes any injury, illness, or disease incurred or aggravated while the National Guard or Reserve member is in a duty status, either inactive duty (such as reserve drill) or active duty status. This includes the time period when the member is traveling directly to or from the location where he or she performs military duty. The National Guard or Reserve member’s service determines eligibility for LOD care, and the member receives a written authorization that specifies the LOD condition and terms of coverage. Note: The Defense Enrollment Eligibility Reporting System (DEERS) does not show eligibility for LOD care.

LOD coverage is separate from any other TRICARE coverage in effect, such as:

• Transitional health care coverage under the Transitional Assistance Management Program (TAMP) or Transitional Care for Service-Related Conditions (TCSRC) program
• Coverage under the TRS program option

Whenever possible, MTFs provide care to National Guard and Reserve members with LOD conditions. MTFs may refer National Guard and Reserve members to civilian TRICARE providers. If there is no MTF nearby to deliver or coordinate care, the MMSO may coordinate non-emergency care with any TRICARE-authorized civilian provider.

Humana Military forwards any claim that was not referred by an MTF or pre-approved by the MMSO to the MMSO for approval or denial. The provider should submit medical claims directly to Humana Military unless otherwise specified on the LOD written authorization or requested by the National Guard or Reserve member’s Medical Department Representative. When submitting claims for a National Guard or Reserve member with an LOD condition, the service(s) listed on the claim must be directly related to the condition documented on the LOD written authorization.

If the MMSO denies a claim for eligibility reasons, the provider’s office should bill the member. The MMSO may approve payment once the appropriate eligibility documentation is submitted. It is the National Guard or Reserve member’s responsibility to ensure that his or her unit submits appropriate eligibility documentation to the MMSO and that the MMSO authorizes all follow-up care.
     

Coverage When Activated for More than 30 Consecutive Days

National Guard and Reserve members with activation orders for more than 30 consecutive days are TRICARE-eligible for 180 days prior to mobilization and until either deactivation prior to mobilization, or until 180 days after deactivation post-mobilization. They are considered ADSMs and must enroll in TRICARE Prime or TPR, depending on location, when they reach their final duty stations.

Family members of National Guard and Reserve members may also become eligible for TRICARE if the National Guard or Reserve member (sponsor) is called to active duty for more than 30 consecutive days. These family members may enroll in TRICARE Prime or TPRADFM, depending on location, or they may use TRICARE Standard and TRICARE Extra. They are also eligible for dental coverage through the TDP. Sponsors must register their family members in DEERS to establish TRICARE eligibility.

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