An 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:
Whenever possible, military hospitals and clinics provide care to National Guard and Reserve members with LOD conditions. These facilities may refer National Guard and Reserve members to civilian TRICARE providers. If there is no military hospital or clinic nearby to deliver or coordinate care, the DHA-GL may coordinate non-emergency care with any TRICARE-authorized civilian provider.
Humana Military forwards any claim not referred by a military hospital or clinic or pre-approved by the DHA-GL to the DHA-GL for approval or denial. The provider should submit medical claims directly to Humana Military unless otherwise specified in the LOD written authorization or requested by the National Guard or Reserve member’s medical department representative. When submitting claims for a member with an LOD condition, the services listed on the claim must be directly related to the condition documented in the LOD written authorization.
If the DHA-GL denies a claim for eligibility reasons, the provider’s office should bill the beneficiary. The DHA-GL 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 DHA-GL and that the DHA-GL authorizes all follow-up care.