Transitional Care for Service-Related Conditions
The Transitional Care for Service-Related Conditions (TCSRC) Program extends TRICARE coverage to former active duty, Guard, and Reserve members for certain service-related conditions beyond their regular 180-day TAMP coverage period. The benefit is available worldwide.
Eligibility for TSCRC
If you are eligible for care under TAMP and have a newly-diagnosed medical condition that is related to your active-duty service, you may qualify for an additional 180 days of care for your specified service-related condition. To qualify for TCSRC, your medical condition must be:
- Service-related
- Newly discovered/diagnosed during the 180-day TAMP period
- Able to be resolved within 180 days
- Validated by a DoD physician
Once your medical condition is validated by the DoD, your TCSRC coverage is reflected in the Defense Enrollment Eligibility Reporting System (DEERS).
TCSRC Benefits
If you qualify, you'll receive medical care for that condition, and that condition only, as if you are still on active duty, with no copayments or cost shares applied. If you have multiple service-related conditions, each condition will have its own enrollment and coverage period.
TCSRC enrollment includes eligibility for prescriptions necessary to treat the service-related condition(s). You can fill these prescriptions at a military treatment facility (MTF), retail network or non-network pharmacy, or through the Mail Order Pharmacy. If you are near an MTF, you may want to get your prescriptions filled there. If not, the Mail Order Pharmacy would be your next best option.
If you use a network or non-network retail pharmacy during the TCSRC benefit period, you may experience out-of-pocket cost, but be assured if you send a copy of your TCSRC approval letter with your claim form you will be fully reimbursed for medications related to your TCSRC-authorized condition. TCSRC will not cover the cost of medications unrelated to the treatment of a TCSRC-authorized condition. Visit www.express-scripts.com/TRICARE for details about filing a prescription claim.
Enrollment into this program does not affect your eligibility for any other TRICARE program for you and your family members. (i.e. Deactivated Guard/Reserve members in the Selected Reserve may enroll in TRICARE Reserve Select and use TCSRC benefits for qualified service-related conditions.)
Getting Started
To see if you qualify for the TCSRC Program, follow these simple steps:
- Prepare a letter requesting coverage under the program, and indicate the condition(s) for which you are seeking extended care. Download a Sample Letter. We suggest that you validate with your unit that you show as TAMP-eligible in DEERS.
- Collect copies of all documents showing the condition(s) is/are service-related (please do not send any original documents). Examples include clinical notes from your medical records or a line of duty report. Other documentation (i.e. medical notes, accident notes, letter/statement from Commanding Officer saying it happened on active duty, etc.) may be considered if the medical condition is not documented in your medical records.
- Download the Application Worksheet. Complete your portion of the Application Worksheet and give the Provider Checklist & Instructions to your provider to complete indicating the condition(s) is/are resolvable within 180 days. The doctor who completes the Provider Checklist should be the provider who treats your condition(s). For example, if you are referred by your primary care manager to a specialist for the medical condition, then the specialist should complete the Provider Checklist. See the section below about finding a provider.
- Submit your letter with the completed Application Worksheet and all documentation showing the condition is service-related and can be resolved within 180 days to the Military Medical Support Office Central Cell:
TRICARE Management Activity
Military Medical Support Office
1637 Central Cell
P.O. Box 886999
Great Lakes, IL 60088
Fax: 1-866-531-7881
If you have questions about qualifying for TCSRC benefits, contact the MMSO at 1-888-647-6676 and follow the prompts for assistance. Once the DoD physician validates you are eligible for the TCSRC program, you'll be sent a letter confirming your eligibility.
If you live in the United States, you'll also receive an authorization letter from your regional contractor. The authorization applies to the entire episode of care and expires 180 days after the DoD physician's date of validation.
If you live overseas, contact International SOS to get specific information about your benefits and coverage. Click here for country-specific toll-free numbers.
Finding a Provider
Any MTF or TRICARE-authorized provider (network or non-network) can complete the Provider Checklist portion of Application Worksheet. When approved, this is most likely the same doctor who will provide the care for your medical condition during the 180-day TCSRC coverage period.
MTF: If you live near an MTF in the United States or overseas, you may seek care from that MTF.
Network Providers: If MTF care is not available, we recommend you visit a network provider, if one is available. Visit your region's network provider directory, listed below, to find a network provider near you or contact your regional contractor for assistance.
- North Region Provider Directory 1-877-874-2273
- South Region Provider Directory 1-800-444-5445
- West Region Provider Directory 1-888-874-9378
Non-network Providers: If a network provider is not available, you may visit a TRICARE-authorized, non-network provider. There are two types of non-network providers, participating and non-participating. Participating providers agree to accept the TRICARE allowable charge as payment in full for their services and will file claims for you.
If you seek care from a non-participating provider, you may have to pay up front for care and file a claim for reimbursement. Be sure to always include a copy of your TCSRC approval letter when filing a TCSRC claim. Send your claims to your regional contractor at one of the following addresses:
|
North |
Health Net Federal Services, Inc. |
|
South |
TRICARE South Region |
|
West |
West Region Claims |
Overseas Providers: If MTF care is not available overseas, you may visit any host-nation provider. The overseas contractor, International SOS, has established a network of qualified providers in all overseas areas. For assistance finding an overseas provider:
- Contact International SOS or
- Search the online provider directory
In most cases overseas, you'll need to pay up front for the care and submit paper claims for reimbursement. Be sure to always include a copy of your approval letter when filing TCSRC claims. Send your claims to the following address from all overseas areas:
WPS - Active Duty Claims Processing
P.O. Box 7968
Madison, WI 53707-7968
If You Do Not Qualify
If you have a service-related condition that cannot be resolved within the 180-day TCSRC period and therefore cannot be approved for the TCSRC Program, you may be eligible to receive medical care for this condition through the Department of Veteran's Affairs (VA). The VA determines eligibility for VA benefits; call 1-877-222-8387 or visit www.va.gov for more information. Additionally, if you are currently in the National Guard or Reserves, you may want to contact your unit to see if you qualify for line of duty benefits.
If you have additional information from your provider that supports his/her belief that your condition can be resolved within 180 days, you may request reconsideration of your application in writing within 30 days of the date of this letter. Supporting documentation and requests for reconsideration may be sent by fax or mail to:
TRICARE Management Activity
Military Medical Support Office
1637 Central Cell
P.O. Box 886999
Great Lakes, IL 60088
Fax: 1-866-531-7881
What if I'm enrolled in the US Family Health Plan?
Your US Family Health Plan provider cannot provide care to active duty members so they cannot participate in the TCSRC Program. To qualify, you must have treatment from an MTF or TRICARE-authorized provider as described above and your TCSRC enrollment is managed by the regional contractor in your region. The care for your service-related condition is treated separately than any care you would receive from your US Family Health Plan provider.
What if I'm eligible for Medicare?
Medicare does not pay claims for active duty care. Since the TCSRC benefit provides care as if you were on active duty, all claims related to your approved service-related condition must be filed with the appropriate regional claims processor. See above for your claim address.
Last Modified:April 26, 2012
Print