Line of Duty for Service Members

LOD for RC members is defined as an injury, illness or disease incurred or aggravated while in a qualified duty status (orders 30 days or less).  The incurred or aggravated condition must be military service connected.

LOD is not a government lifetime health plan. It’s a special eligibility status to treat a specific condition for up to one year.

The process for getting LOD care depends on where you’re located:

In the United States

Has your period of orders expired? MMSO or the military hospital or clinic will use the LOD determination to authorize any health care that is related to the injury, illness or disease identified in the LOD. All non-related health care or pre-existing health care matters are not covered under the LOD.

The authorization will cover care for up to one year from the diagnosis date. Note: If you’ve been referred to the Integrated Disability Evaluation System (IDES), you may not qualify.

Only a military hospital or clinic or MMSO can order the regional contractors to authorize LOD care. This helps make sure that LOD claims process and pay correctly.

Emergency and Urgent Care

Get care at your closest facility. Then, ask your unit to submit DHA-GL Worksheet-01: Medical Eligibility Verification and a unit sign-in sheet, muster form, or orders. Your unit must send these documents to MMSO as soon as possible after you get care. 

Care at a Military Hospital or Clinic

Do you live within 50 miles or one hour’s drive time? Military hospitals and clinics will oversee and authorize your LOD care. You must get LOD care at a military hospital or clinic if you live within this distance. You’ll need to show proof of drill status (muster form, Inactive Duty Training orders) for initial care.

The military hospital or clinic will authorize additional care as needed. This includes any care outside the military hospital or clinic.

Civilian Remote Care

Do you live more than 50 miles or one hour’s drive time? You may be able to get civilian remote care.

MMSO reviews and authorizes LOD care for these RC members. Your unit must start the LOD process and provide documentation to MMSO.

Authorizations and Claims Processing

Submit claims for LOD medical care to your regional contractor. >>Learn More

You’ll need to sign up for your region’s secure patient portal.

You can find:

  • Authorizations
  • LOD claims processing information
  • Explanations of benefits (EOBs)

Sometimes, claims pay incorrectly if you have an LOD condition and another primary eligibility in DEERS, such as:

If this happens, contact MMSO or your military hospital or clinic. They’ll work with the regional contractor to reprocess claims without cost-shares or deductibles.

LOD/Notice of Eligibility (NOE) is limited coverage and separate from other TRICARE coverage. It’s different from:

Overseas

Are you an RC member overseas?

  • A military hospital or clinic can authorize your LOD care.
  • The TRICARE Overseas Program (TOP) contractor can also authorize your LOD care.
  • MMSO doesn’t validate LOD status for RC members overseas, except in the U.S. Virgin Islands.

Care at a Military Hospital or Clinic

Are you near (within 50 miles or one hour drive time) to a military hospital or clinic? If so, you must seek care there.

If the military hospital or clinic can’t treat you, they will submit a referral to the TOP contractor. The contractor will authorize your care from a host nation provider.

Host Nation Care - Remote Care

If you are more than 50 miles or a one hour drive time to a military hospital or clinic, contact the TOP contractor for help.

After confirming your orders/LOD status, the TOP contractor can authorize your care from a host nation provider. They can also help you schedule your appointment.

Tips for RC LOD Members

  • Participate in your own health care. This isn’t a passive process.
  • Make sure your providers have the right TRICARE claims address. 
  • Contact your regional contractor if your provider isn’t filing claims.
  • Use the secure portal for your region.
  • Check the portal to make sure authorizations are on file.
  • Check your explanations of benefits (EOBs) to ensure your claims are paying correctly.

    • Don’t use personal health insurance. Let the LOD authorization and claims process work.

Need Line of Duty Dental Care?

The Active Duty Dental Program provides line of duty dental care. 

MMSO doesn’t authorize LOD dental care. Dental LOD support is available through United Concordia at 1-866-984-2337. 

Last Updated 5/2/2024