Due to staffing and resource concerns at Military Treatment Facilities, DoD had to create a patient care priority system. Authorized patients are to be seen and treated in accordance with the following prioritization:
- Active duty service members.
- Active duty family members who are enrolled in TRICARE Prime (survivors of military sponsors who died on active duty who are enrolled in TRICARE Prime are included in this priority group during the time period they are eligible). Active duty family members who are enrolled in TRICARE Plus fall into this category for primary care appointments only.
- Retirees, their family members, and survivors who are enrolled in TRICARE Prime.
- Active duty family members who are NOT enrolled in TRICARE Prime (survivors of military sponsors who died on active duty who are not enrolled in TRICARE Prime are in this priority group). These beneficiaries may enroll in the TRICARE Plus Program to receive primary care within an MTF (see that section on page 48 for additional details).
- Retirees, their family members and survivors who are not enrolled in TRICARE Prime. These beneficiaries may enroll in TRICARE Plus (see that section for additional details).
- All other eligible persons.
There are certain special provisions in the military treatment facilities access policy, as follows:
- Military members who are not on active duty, but who are entitled to care in a service hospital, are in Priority Group 1. This includes members of reserve components entitled to medical care relating to conditions incurred in the line of duty and members on the Temporary Disability Retired List for required periodic medical examinations.
- NATO and other foreign military members who are entitled to care in an MTF, pursuant to an applicable international agreement are in Priority Group 1, for the scope of the services specified in the agreement.
- NATO and other foreign military members' family members who are entitled to care, pursuant to an applicable international agreement, are in Priority Group 2, for the scope of services specified in the agreement.
- As indicated in the priority list above, survivors of sponsors who die on active duty, as provided in the law-10 U.S. Code 1076(a)-are, for purposes of access to military hospitals, considered to be together with active duty family members. They would, therefore, be in Priority Group 2 or 4, depending on whether they were enrolled in TRICARE Prime.
- Persons other than those in any of the beneficiary groups identified in Priority Groups 1 through 5 don't have priority access.
- Priority access rules are not applicable to bona fide medical emergencies, or cases in which the providing of certain medical care is required by law, or applicable Department of Defense Directive or Instruction. This includes care for civilian employees who are exposed to health hazards in the workplace or are injured on the job. In certain situations, MTF commanders may grant exceptions to the priority access rules. For example,
- A higher priority may be given to an active duty family that's in Priority Group 4 because TRICARE Prime isn't available where the sponsor is assigned, when the family member is temporarily in a location where TRICARE Prime is available, and needs medical care.
- A particular patient might be given a higher priority, if necessary, for the military hospital to maintain an adequate mix of cases for its graduate medical education programs, or to help maintain the readiness-related medical skills of its medical staff.
- A higher priority might be given to a patient in other unexpected or extraordinary cases, as determined by the hospital commander, in coordination with the military lead agent (a military office that oversees contractor operations in a particular region) for the TRICARE region.
- And, in overseas locations, other exceptions may be established to the extent necessary to support mission objectives. Eligible beneficiaries can get outpatient care from an MTF for free. For inpatient care, you may pay only a small amount for each day. This daily fee is usually much less than the daily costs in a civilian hospital. Furthermore, you don't need a nonavailability statement for care at an MTF, and you don't have to file any claims.