Informing Beneficiaries of Non-Covered Services
TRICARE beneficiaries must be properly informed in advance and in writing of specific services or procedures that are not covered under TRICARE before they are provided. If they choose to be financially responsible for the non-covered services, beneficiaries may sign a waiver agreeing to pay for non-covered services.
However, if the provider does not obtain a legal signed waiver, and the care is not authorized by Humana Military, the provider is expected to accept full financial liability for the cost of the care. In addition, the waiver signed by a beneficiary after the care is rendered is not valid under TRICARE regulations.
For the beneficiary to be considered fully informed, TRICARE regulations require that:
- The agreement is documented and signed prior to the specific non-covered services being rendered.
- The agreement is in writing.
- The specific treatment, date(s), estimated cost of service, and billed amounts are documented.
General agreements to pay, such as those signed by the beneficiary at any time of admission, are not evidence that the beneficiary knew specific services were excluded or not allowable.
Providers should maintain copies of the waiver in their office and fully inform beneficiaries in advance when specific services or procedures are not covered. See the Medical Coverage section of this handbook for a summary of TRICARE covered and non-covered services and benefits.
Waivers of Non-Covered Services
A network provider can utilize the TRICARE Non-Covered Services Waiver form when the beneficiary is properly informed, in advance, that TRICARE does not cover a particular service and he or she agrees in writing to be financially responsible.
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