Who and What is Covered ?

Who and What is Covered? Want to find out whether or not you are covered by the TRICARE health care plans? Read on to find more.

Who and What is Covered?

TRICARE is the military’s health coverage insurance program. As a military person, you are automatically entitled to the benefits that accompany TRICARE and are included under the coverage. This program is implemented and is available for acquisition for all seven service branches of the United States militia: Navy, Marine Corps, Air Force, Army, Coast Guard, Public Health Service and the National Oceanic and Atmospheric Administration. To utilize and access the benefits of TRICARE, it is essential to be enrolled and registered validly and officially, in the Defense Enrollment Eligibility Reporting System, which is colloquially referred in military vernacular by its simple acronym, ‘DEERS’. After dutiful registration in DEERS, you are deemed to be eligible to receive military health care gains.

However, it is not only military personnel that are covered under TRICARE. It extends beyond them and provides medical coverage for the immediate family members of the military. The beneficiaries of TRICARE are broadly split into two ways; those serving or have served in military ranks previously are known as sponsors, who sponsor their immediate families to come under the TRICARE umbrella. The families therefore form the other type of major beneficiary of TRICARE.  While families are generally taken to be just the spouse and children, TRICARE offers coverage for more than that.

Family Coverage Under TRICARE:

Typical family coverage under TRICARE includes marital affiliates, biological or adopted children, sponsor dependent parents and parents in law. However, instances and circumstances of family eligibility differ. TRICARE eligible family members include:

  1. Marital partners (wife/husband) and single, unwed children of active duty service military affiliates.
  2. Marital dependents and unmarried offspring of retired uniformed service members.
  3. Military Individuals who have been conferred the Medal of Honor and their immediate family members
  4. Former spouses who have remained single and children who are yet single of deceased, retired or active duty uniformed individuals.
  5. Marital dependents and unwed, underage progeny of members of the Reserves and National Guard who are under order and command to serve in active duty for more than thirty days at a stretch or individuals in reserve and the National Guard who are killed while serving in combat duty.
  6. The wives/husbands and their respective single as yet underage children of reservists and members of the National Guard who are killed under any kind of circumstance or condition pertaining to active combat..
  7. Financially and functionally dependent parents and parents in law can also be afforded care coverage under TRICARE under excruciating circumstances.
  8. Unwed, single offspring who are under or have attained the age of twenty-one. This also includes stepchildren who have been legally adopted by the military person in question. TRICARE remains in place even if the spouse gets divorced or remarries. However, if the stepchild was never adopted and if the marriage breaks down due to divorce, TRICARE privileges will be revoked. This does not mean that TRICARE coverage was not there whilst the stepchild’s parents were married.
  9. Children over the age of 21 may be covered if they are excruciatingly handicapped or have disabilities that hinder proper functioning and if the condition was present before his or her 21st birthday.
  10. Children of military sponsors may also be covered under TRICARE till the age of 23, if they are still in school or an institute of higher learning on a full-time basis. It also needs to be proven that the child in question is at least partially (50%) responsible on his or her parents.
  11. Children who are lawfully placed in the guardianship of an active or retired service member.
  12. The offspring of incumbent or past military service members who are illegitimate may also qualify as legible candidates for TRICARE coverage, but certain conditions may apply and consulting a Health Benefits Advisor may be helpful.
  13. In addition, some family individuals of incumbent service members may be eligible for medical coverage if their military sponsor is under court ordered separation and is martialed for spousal and child abuse.
  14. Spouses and children of the North Atlantic Treaty Organization (NATO) and Partners For Peace (PFP) country ambassadors who are under official authority, allowed to travel and stay with the NATO and PFP country spokespersons. They are eligible for out- patient benefits only as long as they are currently living in or temporarily staying in (travelling through) the United States of America.
  15. Other family members registered in the Defense Enrollment Eligibility Reporting System (DEERS).
  16. Former marital partners of uniformed servicemembers (including active, retired and former), but they need to meet certain requirements:
  • They must not remarry; if they do so TRICARE privileges will be revoked in any case, even though the new marriages are dissolved as a consequence of death or divorce.
  • They should not have an existing or additional health insurance plan such as that covered by the employer.
  • They should not have been married at all in the past to any of the NATO or PFP nation members.
  • It is essential that the person has been married to the same member or former member for at least two decades.

What is covered?

TRICARE is medical insurance, meaning that it will only cover the medical aspects of your life. This insurance will only benefit you medically in case of any type of emergency or procedure that is required. Normally, TRICARE benefits will depend upon and vary according to the type of plan that is in intended usage. TRICARE covers hospitalization and outpatient visits as well as procedures involved in preventive care and maternity care. Immunizations as well as mental / behavioral health care are also included under the coverage program. Furthermore, TRICARE covers most inpatient and outpatient care that is medically necessary and proven. It also includes a yearly physical exam as well as any kind of surgery, be it robotically assisted, preexisting conditions, pharmaceutical prescriptions and other types of medical emergencies, including but not limited to cosmetic surgery as a result of disfigurement due to burns and so on.  Pharmacy services ensure that you are provided with the prescription drugs you need, when you need them in a timely and cost effective manner. TRICARE covers most prescription drugs approved by the U.S. Food and Drug Administration (FDA). However, it will not cover over the counter drugs.

You have the right to receive all the hospital care that is necessary for the proper diagnosis and treatment of your illness or injury. According to Federal law, your discharge date must be determined solely by your medical needs, not by Diagnosis Related Groups (DRGs) or by TRICARE payments. You have the right to be fully informed about decisions affecting your TRICARE coverage and payment of your visit to or stay in the hospital and any post-hospital services.

Tricare Admin