Tricare FAQ

Can Tricare recover from UM/UIM policy benefits?

  

Tricare will pursue subrogation against UM/UIM policy benefits pursuant to 10 U.S.C. § 1095. 


“The United States shall have the right to collect from a third-party payer reasonable charges for health care services incurred by the United States on behalf of such person through a facility of the uniformed services to the extent that the person would be eligible to receive reimbursement or indemnification from the third-party payer if the person were to incur such charges on the person’s own behalf.”

“(b)No provision of any insurance, medical service, or health plan contract or agreement having the effect of excluding from coverage or limiting payment of charges for certain care shall operate to prevent collection by the United States”

Can Tricare recover for future medical expenses and is there a set-aside required for this?

 Tricare can incorporate identifiable future costs related to the compensable injury within their asserted subrogation/recovery claim. These future considerations are identified and satisfied during the finalization of the subrogation recovery claim pursuant to 32 C.F.R. § 199.12(i)(3). 

What is an Attorney Protection Agreement and does the beneficiary’s attorney have to sign it?

  

The United States Government directs the recovery units to send this form to the Plaintiff’s attorney to ensure cooperation and seek written agreement that the Government will be protected in the injured parties action through subrogation. This document acknowledges Tricare’s claim pursuant to 32 C.F.R. § 757.18. The FMCRA provides Tricare with both a subrogee/intervention right and an independent right of recovery to payments when a third party is responsible for payments for all or part of the same medical treatment for which Tricare provided or made payment to a non-government provider. 

Does Tricare reduce(offset) its Claim for attorney’s fees and costs?

No. The Government asserts a prohibition from paying private counsel fees pursuant to 5 U.S.C. § 3106.