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Eligibility

Eligibility

Q1:

I am a Reservist who went to the Emergency Room while I was on drill/Annual Training. What do I do now?

A:

Have your unit representative submit the DHA-GL Worksheet-1, the certified orders/roster, and the Emergency Room/Urgent Care provider’s notes. These documents will validate that you were eligible to receive medical care at government expense. If eligible, TRICARE contractors will pay the provider for care with zero cost-shares or copayments.

Q2:

If my unit representative does not submit the required documentation to validate my eligibility, may I submit it?

A:

No, your eligibility validation package must come from your unit representatives.

Q3:

I am a Reservist. How does my unit representative submit my eligibility documentation?

A:

If you are U.S. Navy Reserve, U.S. Marine Corps Reserve, U.S. Air Force Reserve, or Air National Guard, your unit representative can send required documents to our specified organization email box: dha.great-lakes.j-10.mbx.mmso-lod-misc@health.mil. (Do not send bills)

**Army: If you are Army National Guard/U.S. Army Reserve, your unit representative must use eMMPs via MEDCHART to submit your eligibility.

Note: This box can only accept emails from .mil addresses.

Q4:

I am a Reservist/National Guard in the Army. Why does my unit have to use MEDCHART?

A:

This is not a Defense Health Agency, Great Lakes mandate. All Army National Guard/U.S. Army Reserve requests are required by the National Guard Bureau and Office of the Chief of Army Reserve to be submitted via the Electronic Medical Processing System (eMMPS/MEDCHART). Defense Health Agency, Great Lakes will not accept Army Reserve Component eligibility packages submitted by mail, fax, or email.

** If you are a Unit Administrator seeking more information about MEDCHART access or instructions, please contact your chain of command.

Q5:

I am a Reservist on orders more than 31+ days. When should my eligibility be submitted?

A:

Your unit representative does not need to submit your eligibility. Your Defense Enrollment Eligibility Reporting System record should reflect your time as active duty which will prompt TRICARE to pay your claims as TRICARE Prime Remote. If you need follow-up care after your orders end, your unit representative should submit a pre-authorization request along with the required documentation.

Q6:

Why does Defense Health Agency, Great Lakes require CAC verified digital signatures?

A:

The requirement for CAC verified signatures validates and confirms the identity of the unit representative who submitted the document.

Q7:

I am a Reservist who went to the Emergency Room/Urgent Care while on drill status. Why was my eligibility denied?

A:

Defense Health Agency, Great lakes reviews each case. If the eligibility documents submitted by your unit representative did not meet incurred criteria or aggravated criteria, the government is not obligated for the payment. Some examples are:

  • Existed prior to (drill) service
  • Gross negligence
  • Misconduct
  • Drug use
  • Sexually transmitted infections
  • Annual health assessments
  • Behavioral health
  • Alcohol misuse/withdrawal
  • Medication refills
  • MRI

Q8:

What does “eligibility on file” mean?

A:

"Eligibility on file" means we have verified and approved your eligibility documents. The claims sent to TRICARE that are associated with your line of duty injury or illness will be authorized for payment.

Last Updated: February 02, 2024
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