Can teen dependent’s baby get Tricare via grandfather?
September 14th, 2011 | TriCare Help | Posted by Military Times
My 14-year-old son’s girlfriend, who is 16, is pregnant. She is on Tricare because she is a dependant of her Army dad. What would we have to do to enroll the baby on Tricare with the Army grandfather? Since they are both minors and the baby will be living with the mom.
You wrote that the mother is a Tricare beneficiary under the sponsorship of her father. Presumably, he is an active duty or retired uniformed service member.
Unless she marries, the mother’s Tricare eligibility can continue under her father’s sponsorship until she is 26 years old. That means that all her maternity care can be covered by Tricare.
If she marries, however, she will lose her Tricare eligibility under her father’s sponsorship immediately. In that case, her maternity care would not be covered, as of the date of her marriage.
There is no provision in the law for grandchildren to be eligible for Tricare. That means the baby will not be eligible for Tricare. From the moment of birth, none of his medical care can be covered by Tricare.
The child could be made eligible, however, if he were legally adopted by a suitable uniformed service sponsor, such as the maternal grandfather. In that case, he would become a son. For Tricare eligibility purposes, he would no longer be a grandchild.
For official information about the baby’s possible Tricare eligibility, please call the DEERS Support Office (DSO), toll-free, at 1-800-538-9552. Its personnel can discuss with you any questions regarding Tricare eligibility.
Can family get Tricare once I move in with fiance?
August 17th, 2011 | TriCare Help | Posted by Military Times
I plan on marrying a retired Coast Guard pilot next year, but my children and I have since moved in and combined our families into one unit. Can my two kids and I join Tricare prior to the marriage while living with him?
No; you’ll have to get married first. You and your children will become Tricare-eligible on the day you marry. Your husband, however, will have to register the family with the Coast Guard and DEERS, and get uniformed service ID cards for you before you can use Tricare. Save all your medical bills until he gets that done.
He should call the DEERS Support Office, toll-free, at 1-800-538-9552, if he needs guidance. His Personnel Section can help him with it immediately if nearby; or, he can try a reserve unit with a personnel shop.
Mom’s soon-to-be ex threatening to take away her Tricare
August 12th, 2011 | TriCare Help | Posted by Military Times
My 62-year old mother is in the process of divorcing her husband, who’s retired from the Navy. She is currently covered under his Tricare. They have been married 14 years, only 18 month of which while he was on active duty, so we realize she will not be eligible for Tricare on her own after the divorce. Divorce proceedings may take months, however, and he is threatening to “make a phone call” now and have her dropped from his plan before the divorce is final. Can he do this?
In short, no. Under the law that created Tricare, the benefit flows directly to the beneficiary, not “through” the military sponsor. The sponsor cannot control the beneficiary’s eligibility for Tricare or use of the program. Neither does the sponsor have a legal right to any information about an adult beneficiary’s Tricare claims or medical care without the beneficiary’s written permission. That information is protected by the federal Privacy Act of 1974.
You are correct that your mother’s Tricare eligibility will end when the divorce is final. Tricare will not cover the costs of any medical service she receives after midnight on the day the divorce is final. She and/or her providers, however, may continue to file Tricare claims for medical services received before that time and date. The filing deadline for those claims is one year from the date of the care.
I strongly recommend that you call the DEERS Support Office for official information regarding this matter and confirmation of the information above.The toll-free number is 1-800-538-9552. DEERS can provide official information and guidance about any matter pertaining to Tricare eligibility only. It can’t help with matters concerning Tricare benefits, claims, or payments. Please contact your Regional Tricare Service Center for that information.
Bear in mind that I am not an attorney; while I can tell you what a law or regulation says, I am not qualified to tell you how it applies to a particular person or situation. Only a qualified attorney or official agency can do that.
Can I keep Tricare coverage after divorce from husband?
August 10th, 2011 | TriCare Help | Posted by Military Times
I have been married to my husband for 17 years and we are in the process of getting a divorce. He is stationed in another state. I am a veteran too, but I left the military to raise my children. I know the children will be covered after we divorce, but is there anything I can do to keep Tricare coverage for myself?
The information in your letter leads me to think that you will lose your Tricare eligibility if you divorce your husband. For a spouse to retain eligibility after divorce, he or she must have been married to the same military sponsor for at least 20 years during which time the sponsor accrued retirement credits.
You are three years short of that requirement, according to your letter. If that is correct, you will lose your Tricare eligibility at midnight of the day the divorce is final.
You are correct that the Tricare eligibility of your husband’s natural or adopted children will not be affected by the divorce. Their Tricare eligibility can continue until they are 26 years old under proper circumstances established by law.
Please call the DEERS Support Office, toll-free, for official information and guidance regarding all matters of Tricare eligibility. Your lawyer can also call that office. The toll-free number is 1-800-538-9552.
Does daughter stay eligible if she gets married?
August 8th, 2011 | TriCare Help | Posted by Military Times
Q. I’m a disabled veteran and both my children are currently covered by my Tricare. My daughter thinks that if she gets married, she will still be able to use my Tricare until she’s 26. I don’t think that’s correct. Who’s right?
You are. Under both Tricare’s original 1966 legislation (as amended) and the new law extending children’s eligibility under the parents’ insurance, children lose Tricare eligibility if they marry.
Remember that Tricare eligibility is established by federal law; Tricare does not have the authority to determine whether a given individual meets all the legal criteria for Tricare eligibility. Only the services have that authority by law.
To confirm that with an official source, please contact the DEERS Support Office, toll-free, at 1-800-538-9552.
How does having other insurance affect my Tricare coverage?
July 25th, 2011 | TriCare Help | Posted by Military Times
I am a military spouse, and I work as a nurse, so I have Tricare as well as my employer’s insurance. My employer and the Tricare Outpatient Clinic I visit told me that Tricare would be my secondary insurance, but neither explained what that means. I continued to see my Tricare provider and they referred me to outside doctors when their own staffing was low at the military treatment facility. Triwest is now asking all providers they had previously authorized to pay them back, and sending me notices that I owe for services they authorized with these providers. They claim they did not know I had another insurance when I had previously filled out papers at the Tricare clinic when I started coverage under my employer’s plan. How does having another insurance affects my benefits through Triwest?
When a Tricare beneficiary has other health insurance, federal law requires that Tricare must always be the last payer. That means all claims for civilian medical care must be filed first with the OHI. When the OHI has paid its maximum and has issued the beneficiary an Explanation of Benefits (the report you get from an insurer showing all of its actions in paying your claim), you may file a Tricare claim.
The Tricare claim must consist of (1) a properly completed Tricare Claim Form DD2642; (2) copies of exactly the same itemized medical bills as were sent to the OHI; and, (3) a copy of the OHI’s EOB showing the way it processed (paid or denied) each of the charges on the medical bills. You must send the completed package to the Tricare claims processor for your state or ZIP code.
(You can download official claim forms and look up the filing address here.)
As last payer, Tricare will pay all, or most, of whatever the OHI did not pay for the medical services on the bills.
You didn’t mention if you have Tricare Standard or Tricare Prime. Tricare Standard is free; Tricare Prime costs $230 per year for one person, or a maximum of $460 for a family of two or more people.
Your mention of using a military treatment facility leads me to think you have Tricare Prime. Unlike Tricare Standard, Tricare Prime functions like a Health Maintenance Organization (HMO). You may use only the health care providers that are enrolled in Tricare Prime’s Provider Network unless you are referred to other providers by Tricare Prime. According to your letter, that was the case with your medical care.
As you report, Tricare is requesting that you refund its payments made in error. According to the information in your letter, Tricare paid in error because you failed to report that you had OHI, and did not file first with the OHI as required by law. No, the cops are not going to come knocking on your door.
But, you do have some problems with having to return payments made in error by Tricare. Pursuant to that, you need more help than Tricare Help can give you.
Please write to the Tricare Headquarters about this matter. The address is Tricare Management Activity, 16401 E. Centretech Parkway, Aurora, CO 80011-9043.
With your letter, please explain the problem in detail, include your full name as it appears on your military ID card, your husband’s name and his Social Security number, and a telephone number where you can be reached during the day. Include copies of any correspondence, bills, EOBs, and the like, that pertain to the problem. The more information you can provide, the more efficiently Tricare can serve you.
Married to a brand-new service member: How do I enroll?
July 18th, 2011 | TriCare Help | Posted by Military Times
Q. My husband left last week for Navy Basic Training, and I was wondering if I’m eligible to be on his health insurance plan as a dependent spouse. Neither of us knows what to do to enroll me.
Your husband is responsible for enrolling his family for military benefits, including Tricare. Tell him to go to his Military Personnel Section ASAP to do that. That office will know everything that needs to be done. Until you are properly enrolled in the program, please save copies of all your medical bills and copies of any other documents pertaining to your medical care. You will need that information to file Tricare claims when you are enrolled. You became eligible for Tricare on the first day your husband entered active duty.
In the meantime, both of you need to start learning about your Tricare plan. Depending on where you live, you will be able to enroll in either Tricare Standard or Tricare Prime. If you will live on or very near a military facility (it is not required that it be a Navy facility), your best option is probably Tricare Prime because (1) it is the least expensive for you; and, (2) it allows you to have priority access to a nearby military hospital to get free medical care.
If you live more than 40 miles from a military hospital, or if it would be difficult for you to get there for care, your other option is Tricare Standard. Under Standard, you will get care from Tricare-authorized civilian doctors and hospitals. I strongly advise those who are enrolled in Standard to consider buying a Tricare supplement from one of the retired military associations. A supplement will pay most or all of what Tricare does not. Usually that will be your Tricare deductible and copayment.
You must get any civilian medical care from Tricare-authorized providers only — those who are registered with Tricare and are authorized to be paid by Tricare for medical care rendered to Tricare beneficiaries. Tricare cannot pay for care received from a provider that is not Tricare-authorized.
If your doctor or other provider is not Tricare-authorized and wants to become an authorized provider, tell him that Tricare.mil maintains an entire section to inform providers about the program. There, the provider can learn about Tricare authorization, Tricare coverage, and how Tricare pays providers.
How do I tell Tricare that a beneficiary has died?
July 15th, 2011 | TriCare Help | Posted by Military Times
My father was retired military and he died several years ago. My mother has been receiving Tricare benefits while she was in a nursing home until she died last week. I need to notify Tricare of her death. Whom should I contact? Also, does Tricare provide any kind of burial benefits?
Please accept my sincere condolences for your loss.
Tricare does not provide death or burial benefits. To notify Tricare of your mother’s death, call the DEERS Support Office, toll-free, at 1-800-538-9552. DEERS will need your Mother’s full name as it appears on her military identification card, your father’s full name and his Social Security number, your Mother’s date of death, and the name, address, and telephone number of the nursing home.
Establishing paternity for Tricare eligibility
May 12th, 2011 | TriCare Help | Posted by Military Times
If an unmarried, active-duty father acknowledges paternity of a child, is the child eligible for Tricare without a paternity test? A paternity test can be difficult when the service member is deployed. Also, is the father’s name on the birth certificate enough to establish paternity?
All of Tricare’s operations — all of its rules and procedures — are governed by federal law and regulation. In the case of a birth outside of wedlock, I believe the law specifies that paternity must be established by judicial determination. That is, a court must issue a statement certifying that the presumed father is, indeed, the child’s biological parent. Merely naming the “father” on the birth certificate is not enough.
As I am not an attorney, and your question has legal implications, I am not qualified to provide the sort of information you are seeking. I suggest that you call the DEERS Support Office, toll-free, at 1-800-538-9552 for official information regarding the matter.
What happens if my husband passes away?
April 26th, 2011 | TriCare Help | Posted by Military Times
Q. My husband retired from the Air Force in 1995 and immediately started another career with a firm with great benefits. As a result, we did not enroll in Tricare Prime and have used Tricare as our secondary insurance in only a handful of situations. Now he is losing his battle with cancer and will soon die. At that time, I will lose all my health benefits. Since I am only 60, I will not qualify for Medicare for several more years.
My question is: How do I enroll in Tricare Prime? Who should I contact and what documentation will I need?
As a widow, you will retain your eligibility for Tricare for the rest of your life unless you remarry. If you remarry, you will forever lose your eligibility under your present husband’s sponsorship, even if the second marriage ends by death or divorce.
From the present time until you become entitled to Medicare at age 65, you can be enrolled in either Tricare Standard or Tricare Prime. Tricare Prime is not available everywhere, however. It is usually available only within a 40-50 mile radius of a military hospital.
When you become entitled to Medicare at age 65, you will become eligible for Tricare for Life. Tricare for Life, or TFL, is a Tricare plan that combines the full benefits of Medicare Part A and Part B with the full benefits of Tricare Standard. Tricare Standard will act as a free Medicare supplement for the rest of your life. Tricare for Life members are not eligible for Tricare Prime. They must be enrolled in Tricare Standard as their companion to Medicare under Tricare for Life.
In the meantime, for official information about Tricare eligibility for widows, and for guidance about becoming enrolled in Tricare Standard or Tricare Prime, please call the DEERS Support Office, toll-free, at 1-800-538-9552.