You might have undergone a massive change in your personal life. For example, you might just have remarried or you might have left for university away from home. Find out what happens to your Tricare coverage here.
During your lifetime, you may undergo different changes. These changes can, in turn, lead to a change in the benefits that you can avail under the Tricare program.
If you get married, then your spouse will also be considered eligible for Tricare benefits. The spouses of all actively serving members, men and women who have retired from their posts in the military and members of the National Guard and Reserve qualify to receive benefits from the various Tricare health care options that are available. Please note here that spouses of the same sex are also available.
In some cases, however, marriage can also lead to an end to Tricare benefits. This occurs when a survivor’s widowed spouse marries again, or an ex-spouse remarries. Furthermore, if an adult child (who was previously using the Tricare Young Adult health care plan) gets married and then he or she is no longer eligible for receiving benefits under Tricare.
If there is a change in your marital status, then it is your job to make sure that you register the spouse in DEERS (which is the Defense Enrollment Eligibility Reporting System) immediately. This can be done at any ID card office. In order to register a spouse, some documentation will be required, such as the certificate of marriage, birth certificate of the spouse, as well as a photo ID of the spouse and his or her Social Security card. You may present original documents or copies of these documents that have been certified or attested.
The kind of health care plan that your spouse can choose depends on where you are living and what your current military status is. A few programs that your spouse may be eligible for include the Tricare Prime health care plan (in which your spouse will have to be enrolled), the Tricare Standard plan and Tricare Extra health care option. In addition to this, other programs available include the US Family Health Plan, Tricare for Life and Tricare Standard Overseas health care plan. If you are an actively serving member of the military forces, then your spouse might be able to register for other Prime health care plans along with you, such as the Tricare Prime Remote health care plan, Tricare Prime Overseas health care plan and Tricare Prime Remote Overseas health care plan.
For spouses, two dental care plans are available, which are not included in the Tricare health care plans. The family members of men and women who are actively serving in the military forces and the members of the National Guard and Reserve can register for the Tricare Dental Program, while the members of the families of service members who have retired can register for the Tricare Retiree Dental Program.
At the end, the total cost of health care will depend on which health care plan your spouse has, as well as the current military status of the sponsor.
In the unfortunate case of a divorce, a sponsor is required to update DEERS (Defense Enrollment Eligibility Reporting System). The divorce decree needs to be added to that. A divorce will not lead to any change in the eligibility of the sponsor for the Tricare health care plans that he or she is currently enjoying. However, there may be a change in whether the former spouse of the sponsor will be eligible or not. If there are any biological children of the two former spouses or any adopted children, a divorce will have no effect on their eligibility.
Unless certain requirements are met, a former spouse will no longer have any access to the Tricare health care plans once a divorce has taken place. However, if these requirements are met, then the individual may continue to have access to the Tricare heath care plans. However, now the individual would have to use his or her own name and own health benefit number in order to access the health care services offered, or to file any claims for reimbursement. The sponsor’s name or health benefit number (as listed in DEERS) will no longer be used.
As for the children, both adopted and biological children will continue to have access to health care benefits under Tricare until they reach a certain age. However, it is essential for the child to be classified as a dependent if he or she is to remain eligible for the Tricare health care plans. In essence, this means that this child cannot be married and cannot be an actively serving member of the military forces either. Once your child has grown up (that is, not considered a dependent anymore) he or she has the option of enrolling for the Tricare Young Adult health care plan until the age of 26. The same rules will not, however, apply to any stepchildren. If the sponsor himself or herself did not adopt his or her stepchildren, then as soon as the divorce decree has been added to DEERS, these stepchildren will no longer be considered eligible for receiving Tricare health benefits.
The kind of care that an eligible child will receive depends on three main factors: the custody agreement, the military status of the sponsor and the location of the sponsor. If both parents are members of the military force, then either of the two may sponsor the child. If one parent is a civilian (or non-uniformed) and the second parent is a military force member, then the child must be handed his or her ID card when they visit or live with the non-uniformed parent.
Losing Tricare essentially means that you lose the coverage that you previously had for minimum essential health care benefits, in accordance with the Affordable Care Act. In order to avoid the payment of any additional fee for the time period in which you do not have coverage, you can opt for the Continued Health Care Benefit Program. This program provides temporary coverage. There is always the option of just searching though the health insurance market – you may come across a civilian health care plan that would suit both your budget as well as your needs.
If a Tricare health care plan is held along with any other form of health insurance, then Tricare will always assume the role of second payer. If a divorce takes place and your child is covered by a health insurance plan from the former spouse who is not a military force member, Tricare will still take the role of a second payer. Even if the child is visiting or living with the civilian parent, Tricare will still be the second payer for any health care services that the child has to avail.
There will be no change in your eligibility status for any Tricare health care plan if you happen to move. However, there might be a slight change in the number of health care plan options that you have available to you. There are a few factors that you need to be mindful of if you are moving. Firstly, you should not take yourself off a health care plan before you have even moved. Until you have moved to the new location, you will receive coverage by the current health care plan that you have enrolled for. Once you have completed the move, it is important for you to immediately update DEERS (Defense Enrollment Eligibility Reporting System) with both your latest address and any changes in your personal information.
If you have a family member who has special needs, it is best to first contact the person’s case manager as well as the regional manager prior to the move. Consulting these two individuals can help you make a better-informed selection of the individual’s new doctor after the move. Furthermore, they can also guide you in finding or accessing any additional resources that you may need to make the transition a smoother process, and minimize any interruption in the coverage that is being offered by the health care plan.
Going to University or College
Although children usually remain eligible up to the age of 21, it is possible to extend this eligibility in certain cases. If the adult child is enrolling in a complete, full-time academic course at a well-known and reputed institution of higher education, or the child’s sponsor is still responsible for providing more than fifty percent of the financial support that the student is receiving, then the child may remain eligible up to the age of 23. The current student status of the child has to be noted in DEERS (Defense Enrollment Eligibility Reporting System). In order to do so, it is essential to obtain a letter from the registrar’s office of the student’s school, which clearly states that the child is a full-time student at the accredited institution of higher education.
The type of health options that are available to a child depends on where the child’s school is located and what the child’s sponsor’s current military status is.
Firstly, the Tricare Prime health care plan is only catering to certain areas, which are known as Prime Service Areas. In order to find out whether an institution falls in these areas, you can check the ZIP code of the school online. Additionally, you can also contact the regional contractor if you wish to find out whether a school is located in a region where Tricare Prime is available. If it is available, then the child can register for the Tricare Prime health care plan. However, if Tricare Prime is not available, then the child can opt for the Tricare Standard health care plan or the Tricare Extra health care plan. In certain areas, the US Family Health Plan is also available.
If a child signs up for the Tricare Prime health care plan, then a primary care manager will be assigned to the child. The primary care manager will be responsible for making all appointments on behalf of the child. If the child consults a medical professional without the primary care manager, then point-of-service fee has to be paid. If the child does not find it convenient to work with a primary care manager, then there is always the option of signing up for the Tricare Standard health care plan or the Tricare Extra health care plan. This would allow the child to consult any provider that has been authorized by Tricare, thus it has greater flexibility.
If a child signs up for the Tricare Prime health care plan, there are very few out-of-pocket costs, unless the child consults health care professionals without going through the primary care manager. In that case, out-of-pocket costs have to be paid. If the child opts for the Tricare Standard health care plan or the Tricare Extra health care plan, then an up front payment may have to be made to the doctor from whom the child has received medical care. A reimbursement can then be obtained by filing a claim later with Tricare. Under the Tricare Standard health care plan and the Tricare Extra health care plan, it is always advisable to visit a network provider in order to avoid any additional costs.
The child may also have the option of registering in a student health plan. Some colleges and universities offer these. In general, these health plans can be classified as other health insurance. In case the child holds any other health insurance, then Tricare will always act as the second payer, while the other health insurance will remain as the primary payer. If the child wishes to register for a student health plan, then it is suggested that he or she should opt for the Tricare Standard health care plan or the Tricare Extra health care plan.
All health care plans that are offered by Tricare provide coverage for the minimum essential health services that an individual needs, as per the Affordable Care Act. Once a regular Tricare health care plan ends, the child may opt to continue the coverage for the minimum essential health care services. Up till the age of 26 years, a child may be eligible to register for the Tricare Young Adult health care plan.
Temporary coverage can also be obtained by the child by signing up for the Continued Health Care Benefit Program. In addition to this, the child can also hunt around in the market for the various health insurance plans that are available, and it is possible that he or she may come across a civilian health insurance plan that he finds more suitable, both in terms of the services that are covered by the plan as well as the costs associated with the insurance plan.
Death of a Sponsor
In the case of the death of a sponsor, all individuals who have been sponsored by him or her will continue to receive access to the Tricare health care plans. The types of health care plans that can be accessed and the cost of these plans depends on the military status of the sponsor at the time of his or her death, as well as your relation to that sponsor (that is, are you a spouse or a child?). In most cases, spouses can continue with their Tricare health care plan, unless he or she chooses to remarry.
At the time of death, if your sponsor was an actively serving duty member, then you, as a spouse, will be covered by Tricare as a family member of an actively service duty member for a period of three years. However, after that time period, your status will be changed and your health care plan will change accordingly; you will now be covered as a family member of a retired member of the military forces. In most cases, the Tricare health care plan will continue to cover the children, unless they cross the age limit that has been set or otherwise. If your spouse had already retired from his or her post in the military forces at the time of his or her death, there will be no change in the Tricare health care coverage that you will be receiving. If your spouse was a member of the National Guard or Reserve at the time of his or her death, then you can receive coverage for health care services by Tricare if the sponsor himself or herself was being covered by the Tricare Reserve Select health care plan or the Transitional Assistance Management Program. In addition to this, as a spouse of a deceased member of the military forces, you may also be eligible to access health care benefits in the status of a family member of a retired member of the military forces. If your spouse was a retired member of the National Guard or Reserve, then you can receive a Tricare health care plan only in the event that your late spouse had a Tricare Retired Reserve health care plan.
At the age of 21, an adult child can be eligible for purchasing a Tricare Young Adult health care plan. If the adult child is a full-time student, then this age condition is set at 23 years of age. In order to receive coverage by the Tricare Young Adult health care plan, however, the adult child has to be unmarried and has to have his or her own health insurance that has been sponsored by an employer. In addition to this, it is, of course, essential for the sponsor to have had a Tricare health care plan at the time of his or her death.
In the case of deployment of your sponsor, it is essential that all members of the family should be fully aware of the Tricare health care plan and how to go about the process of accessing health care benefits. Before going on deployment, it is advised for all sponsors to give a copy of the orders to the family members. Secondly, a Power of Attorney should also be prepared. In addition to this, any required paperwork should be filled out, which would allow all members of the family to obtain a copy of the medical records, as well as any additional information about the personal health of the family. Furthermore, in order to be on the safe side, any essential financial arrangements should be made by the sponsor before he or she goes on deployment. This includes making any allotments or looking after the automatic payment of any bills.
It is essential for the sponsor to ensure that all information about his or her family is regularly updated in DEERS. There is always the possibility that something happens while the sponsor is away on deployment, which may lead to a change in the family’s status. For this reason, it is important for a spouse or a responsible member of the family to know how to make any changes to the information updated in DEERS. Furthermore, it would be advisable to update any ID cards if they are nearing their date of expiry.
The sponsor who is to be sent away on deployment should make sure that his or her family knows what the procedure is of accessing health care benefits during his or her absence. In order to help them, the sponsor may draw up a list of all important contact numbers. In order to obtain the latest contact numbers, you can visit the Contact Us page on the Tricare website. Here, you will be able to see the contact numbers of the regional contractors as well as the primary care provider or primary care manager, who is going to be the first point of contact for the family if they wish to make an appointment to receive any health care services. In addition to this, the sponsor should also carefully review the information about the Tricare health care plan that is held by the family. The sponsor should also talk to the family about the process of getting prescriptions filled and where they can be filled from.