TRICARE ECHO provides services to Active Duty Family Members (ADFM) who qualify based on specific behavioral or physical disabilities. It offers beneficiaries an integrated set of services and supplies beyond those offered by basic TRICARE health benefit programs (e.g., TRICARE Prime, TRICARE Select). Potential ECHO beneficiaries must be ADFMs, have qualifying conditions and be registered in the Exceptional Family Member Program (EFMP). Each service branch has its own EFMP and enrollment process.
Under certain circumstances, this requirement may be waived. To learn more, contact the beneficiary's service branch's EFMP representative or visit TRICARE.mil. A record of ECHO registration is stored with the beneficiary’s DEERS information. Conditions qualifying an ADFM for ECHO coverage may include, but are not limited to:
Note: Active duty sponsors with family members seeking ECHO registration must enroll in their service branch’s EFMP — unless waived in specific situations — and register to be eligible for ECHO benefits. There is no retroactive registration for the ECHO program. Read more about EFMP
TRICARE providers, especially PCMs, are responsible for managing care for TRICARE beneficiaries. Any TRICARE provider (PCM or specialist) can inform the patient's sponsor about the ECHO benefit.
Refer patients to Humana Military for assistance with eligibility determination and ECHO registration. This ensures both the beneficiary and provider have a complete understanding of the benefit and have taken the necessary steps for efficient claims processing.
Providers must obtain prior authorization for all ECHO services, and they may be requested to provide medical records or assist beneficiaries with completing EFMP documents. Network and participating non-network providers must submit ECHO claims to WPS.
ECHO provides coverage for the following products and services:
Note: All ECHO services require prior authorization from Humana Military. Learn more
The government’s limit for the cost of ECHO services combined (excluding EHHC) is $36,000 per beneficiary per calendar year. Beneficiaries are responsible for ECHO cost-shares in addition to cost-shares for basic TRICARE benefits (e.g., under TRICARE Prime, TPRADFM, TRICARE Select).
ECHO cost-shares do not count toward the catastrophic cap. EHHC costs do not count toward ECHO yearly maximum cost-shares.
To learn more about ECHO benefits contact a local ECHO case manager at (800) 444-5445.