Beneficiary rights and responsibilities

TRICARE beneficiaries have rights regarding their healthcare and responsibilities for participating in those healthcare decisions.

Beneficiary rights

  • Easy-to-understand information about TRICARE
  • A choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare
  • Emergency healthcare services when and where they are needed
  • Review information about the diagnosis, treatment and progress of conditions
  • Fully participate in all decisions related to their healthcare or to be represented by family members, conservators or other duly appointed representatives if unable to fully participate in treatment decisions
  • Considerate, respectful care from all members of the healthcare system without discrimination based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information or source of payment
  • Communicate with healthcare providers in confidence and have the confidentiality of their healthcare information protected
  • Review, copy and request amendments to their medical records
  • A fair and efficient process for resolving differences with their health plan, healthcare providers and the institutions that serve them

Beneficiary responsibilities

  • Maximize healthy habits, such as exercising, not smoking and maintaining a healthy diet
  • Be involved in healthcare decisions, which means working with providers in developing and carrying out agreed-upon treatment plans, disclosing relevant information and communicating their wants and needs
  • Be knowledgeable about TRICARE coverage and program options, including covered benefits; limitations; exclusions; rules regarding use of network providers; coverage and referral rules; appropriate processes to secure additional information; and appeals, claims and grievance processes
  • Be respectful of other patients and healthcare workers
  • Make a good-faith effort to meet financial obligations
  • Follow the claims process and use the disputed claims process when there is a disagreement concerning their claims
  • Report any wrongdoing or fraud to the appropriate resources or legal authorities.