Medical coverage and healthcare management

TRICARE beneficiaries are instructed to receive all routine care, when possible, from network providers in their designated regions.

TRICARE covers most medically necessary inpatient and outpatient care. The Specified Authorization Service (SAS) may authorize services for ADSMs that are not regular TRICARE benefits. This overview is not all-inclusive.

TRICARE covers office visits; outpatient, office-based medical and surgical care; consultation, diagnosis and treatment by a specialist; allergy tests and treatment; osteopathic manipulation; rehabilitation services (e.g., physical and occupational therapy, speech pathology services); and medical supplies used within the office.

In general, TRICARE excludes services and supplies not medically or psychologically necessary for the diagnosis or treatment of a covered illness (including behavioral disorder), injury or for the diagnosis and reatment of pregnancy or well-child care. All services and supplies (including inpatient institutional costs) related to a noncovered condition or treatment, or provided by an unauthorized provider, are excluded.

Before delivering care, network providers must notify TRICARE patients if services are not covered. The beneficiary must agree in advance and in writing to receive and accept financial responsibility for noncovered services by signing the TRICARE noncovered services waiver form