Our Medical and dental assistance is limited to those extraordinary, unexpected, emergency situations where, after careful planning and budgeting, a demonstrated financial need remains, after having utilized all available resources. The Medical, dental, or hospital expenses must be medically required, not elective.
While we cannot act as an insurance company, we can provide assistance to help clients through the emergency and reestablish their normal lifestyle for expenses not covered for by TRICARE, the CG, other government agencies, private insurance coverage (including TRICARE supplements), or other organizations.back
Assistance may be considered when emergency treatment is needed and partial payment or a down payment is required for treatment to be received.
In cases where professional counseling is deemed necessary for the client or immediate family member, assistance my be considered to fund services not covered by TRICARE or private insurance.
Assistance may be considered when the overall cost of obtaining necessary medical or dental treatment creates a serious financial hardship, preventing the client from paying the cost share from their own resources.
Assistance may be considered to purchase or rent required durable medical equipment that is necessary to sustain an ill or disabled family member's major life activities when there is a documents medical need for an item and the item is not covered by TRICARE, private insurance, the government, or other sources.
Assistance may be considered for devices such as orthopedic shoes, hearing aids, spectacles, artificial limbs, implants, orthopedic appliances and braces in cases documented by a statement from a doctor or other medical authority attesting that the device is essential for the health and welfare of the individual, and when TRICARE, private insurance, the government, or other sources will not authorize payment.
Assistance may be considered to help with the cost of a caregiver needed to provide temporary care for a client or immediate family member with special medical needs in cases of documented financial need when supported by a statement from a doctor or other medical authority attesting that the services are essential for the health and welfare of the individual, and when TRICARE, private insurance, the government, or other sources will not authorize assistance.
Assistance for orthodontic treatment may be considered only when such treatment is required for medical reasons, not cosmetic reasons, and will not normally exceed 1/3 of total anticipated costs.
Assistance may be considered when long-term treatment is needed to correct or prevent a serious physical handicap or disfigurement. Assistance may also be provided when treatment involves a significant down payment that the client cannot afford and the dentist requires the payment before treatment may begin.
Assistance may be considered for extra living expenses, including travel, meals, lodging, childcare and incidental expenses associated with an emergency medical situation or treatment at a distant facility. A doctor's statement is needed to verify the need for distant care or to justify the travel of family members.
When fully warranted, justified, and supported by the Representative, well-documented cases for other medical and dental expenses may be submitted to the Board of Control for consideration. The Board of Control will consider each request on a case-by-case basis.