Under 20/20/20 rule, will she lose her Tricare if she marries me?
March 30th, 2012 | TriCare Help | Posted by Military Times
You have said a former spouse must be married to the same uniformed service sponsor for at least 20 years during which the sponsor accrued military retirement credits. In other words, the sponsor’s active duty and the marriage must have overlapped by at least 20 years. But in another instance, you’ve also said that a spouse’s coverage is not affected by the death of the sponsor, and that the duration of the marriage is not a factor. I have been seeing a lady who is divorced from a military retiree and has Tricare for Life coverage under his name. I am also a military retiree with TFL. I have been told that if we married and I died before her, she already would have lost Tricare benefits through her ex-spouse, and also from me, since we would not have been married for 20 years. Can you advise?
The two situations you cite in your letter involve two distinct sets of circumstances. One situation involves a former spouse, the other involves a current spouse whose retiree sponsor dies.
The so-called “20/20/20 rule” comes into play in divorce cases involving military retirees. A former spouse may retain Tricare benefits after divorce if the marriage lasted 20 years, the military member served on active duty for at least 20 years, and the marriage and active-duty service overlapped for at least 20 years. A former spouse who meets those criteria may retain Tricare coverage for the rest of her life, under one significant condition: she does not remarry. If she remarries, she loses Tricare eligibility under her former husband’s sponsorship. Once lost, it can never be restored under the retiree sponsor’s name, even if the former spouse’s second marriage ends in divorce or death.
The other situation you cited involves a spouse whose military retiree sponsor dies before her. In this case, the 20-year rule does not apply, for the simple reason that they were not divorced. A spouse covered by Tricare whose retiree sponsor dies before her remains eligible for Tricare for the rest of her life, regardless of how long the marriage lasted — again, unless she remarries. If she does, she loses Tricare eligibility for good under that sponsor’s name.
How this applies to your specific situation: If you and your lady friend marry, she would indeed lose eligibility under her divorced husband’s Tricare for Life sponsorship. However, if you were to properly register her in the Defense Enrollment Eligibility Reporting System (DEERS) as your wife, she would then become eligible for Tricare for Life coverage under your sponsorship. If you die before her, but are still married at the time of your death, she would remain eligible for Tricare under your sponsorship. Regardless of how long you had been married, the 20-year rule would not apply if the marriage was still intact at the time of your death. But again, she would lose her coverage under your sponsorship if she were to remarry again.
If you and your lady friend do marry, your first step should be to contact the DEERS support office toll-free at 1-800-538-9552 to get started on registering her for Tricare coverage.
How soon may wife use Tricare Prime?
February 17th, 2012 | TriCare Help | Posted by Military Times
I am retired Air Force and I just got married. I want to enroll my wife in the Defense Enrollment Eligibility Reporting System so she can be covered under my Tricare Prime, since we live near a military hospital that accepts military retirees for care. How long after enrollment in DEERS will my wife need to wait for benefits?
Your wife’s Tricare coverage became effective on the same day as you were married. For her to use Tricare, however, you must enroll her in DEERS and get her a military ID card. She can use Tricare as soon as her DEERS registration is complete. See your personnel section for help to do those things.
Pregnant and engaged; how soon can I get benefits?
February 13th, 2012 | TriCare Help | Posted by Military Times
I am the girlfriend of a soldier, and I am 10 weeks pregnant. We have every intention on getting married, but I want to know if there is a time limit in which we need to wed in order for our unborn child, and me, to receive military benefits.
You will become eligible for Tricare, including maternity care, on the day you are legally married to the baby’s father. You cannot use Tricare, however, until you are legally married and your husband has contacted his Personnel Section to register you for the program. That takes only a few days.
If the baby is born before you are married, the child’s Tricare coverage will begin on the day he is born. There are some administrative requirements to be met before that, but you can get detailed official information about the Tricare eligibility of a child born out of wedlock by calling the DEERS Support Office, toll-free, at 1-800-538-9552. Be prepared to take notes.
I’m diabetic; when I get married, can I get Tricare right away?
January 27th, 2012 | TriCare Help | Posted by Military Times
My fiancé is active-duty military. I am a diabetic and am on the insulin pump, and I have been told that once I get married and go on Tricare, my care will not be what I’m used to. I have seen the same doctor for 17 years, and I heard Tricare won’t let me pick my doctor. I have also been told I may have to give up my insulin pump and go back to shots. Can you confirm or explain any of that? Also, when we get married, my parents will drop me from their insurance. Do I have to wait for an open enrollment date for Tricare, or is there a way that coverage can start right away?
First of all, if medically necessary and appropriate for the diagnosis, symptoms, and history of the particular beneficiary, an insulin pump can be covered by Tricare.
A problem could arise, however, in your choice of providers. Tricare is not an insurance policy; it is a federal health benefits program. Tricare requires that you receive all civilian medical care from Tricare-authorized providers only. Tricare may not pay for any medical services you receive from an unauthorized provider.
In your case, to retain your same providers, it would be necessary for them to be willing to become Tricare-authorized providers. They can learn how to do that here.
There is no open enrollment period for Tricare. You will become legally entitled to Tricare at the moment you are married. To use Tricare, however, your military sponsor (your husband) must contact his personnel office to register you in the Defense Enrollment Eligibility Reporting System and secure for you a uniformed service identification card. Your coverage will be retroactive to the moment of your marriage.
I changed my name; how do I tell Tricare?
January 23rd, 2012 | TriCare Help | Posted by Military Times
I got married a few months ago and I switched my last name to my wife’s. How can I switch my last name in Tricare? I am enrolling my wife in DEERS next month.
You need to call the DEERS Support Office at 1-800-538-9552.
Personnel at that office will tell you all you need to know, exactly what you need to do, and the way to do it. They will walk you through every step and answer all your questions regarding Tricare eligibility. Be prepared to take notes. DEERS deals with eligibility only and cannot answer any questions about the Tricare program, its benefits, its claims, or its payments. You must contact your Regional Tricare Service Office for official information about any of those things.
Can fiancee keep seeing same doctors when we get married?
January 11th, 2012 | TriCare Help | Posted by Military Times
I am an active-duty sailor and I am getting married in February. My fiancee has bipolar disorder. She is concerned about being able to keep her same doctors and counselor/therapist when we are married and what hoops we may have to jump through with Tricare to make it work. How can I help her ensure she keeps her current doctors?
Tricare is a federal program, but it has a rule in common with most commercial health insurance companies and policies: In order for Tricare to help pay for medical services, the provider of care must be registered with Tricare and be authorized to be paid by Tricare for covered services rendered to Tricare beneficiaries.
Your bride will become legally entitled to Tricare the moment she is married to you., For her to use Tricare, however, you must register her in DEERS and apply for her military ID card. Your Personnel Section will help you do that.
Tricare has no limits or restrictions on its coverage of pre-existing conditions. Mental health care, including pharmacy services, is a Tricare benefit, subject to existing rules regarding the medical necessity and appropriateness of care for the particular patient’s diagnosis, symptoms, and medical history.
Seamless continuity with your wife’s same providers may be a problem for two reasons:
One is the perennial element of military service in that you are subject to periodic transfer to a new location, perhaps across the world. You have little or no control over that element of military service.
The other is whether your wife’s providers are, or are willing to become, Tricare-authorized providers, as I discussed above. A section of the official website was designed especially to inform providers of care about Tricare and its rules regarding providers. Your wife should make her doctors aware of the web site and its provider section, but the decision of whether to become Tricare authorized providers is voluntary and entirely in their hands.
Will fiancee’s grandson be covered if we get married?
January 6th, 2012 | TriCare Help | Posted by Military Times
I am currently in a relationship and would like to get married. My fiancee has legal custody of her grandson. Once we are married, will this child be eligible for care under my Tricare? Also, will any of my fiancee’s pre-existing conditions be covered, such as diabetes?
By federal law, unless you were to legally adopt the grandson, I don’t believe his Tricare eligibility is possible. To confirm that, however, and to explore what other possibilities might exist, call the DEERS Support Office at 1-800-538-9552.
Tricare has no restrictions on its coverage of pre-existing conditions.
After I marry Marine husband, can I get Tricare right away?
December 27th, 2011 | TriCare Help | Posted by Military Times
My fiance is on active duty in the Marine Corps. We are getting married in January. I am currently a flight attendant, so I have my own health insurance right now, but I plan to quit in April when I move to Florida to be with him. Once we get married, is there a waiting period for me to be covered under Tricare, or is it automatic after he has enrolled me?
You will become legally entitled to Tricare at the moment you are married. There is no delay.
If you receive medical care while you still have coverage by your present policy, you must file claims with that plan first. After it has completed all processing of the claim and issued an explanation of benefits, you may file a claim with Tricare as second payer. Tricare will pay all, or most, of what the other plan left unpaid — usually your copayment and, if applicable on that claim, your deductible. For instructions, filing address, and to download claim forms, visit the Tricare website or call your Tricare Service Center.
Here’s how you file a claim with Tricare as second payer:
1. Complete a Tricare claim form DD2642.
2. Attach a copy of the same itemized bill that was sent to the other plan.
3. Attach a copy of the other plan’s EOB reporting its processing of each of the charges on that bill.
4. Send the claim to the proper Tricare claims processor for the state where you live.
For you to use Tricare, your husband must contact his Personnel Section to register you in the Defense Enrollment Eligibility Reporting System, better known as DEERS. (Remember the name. You will soon learn that military folks speak in acronyms.)
DEERS maintains a confidential registry of military beneficiaries and the benefits to which each person is entitled by law. Once registered in the confidential DEERS registry, your name will appear on DEERS under your husband’s Social Security number. DEERS will report that you are eligible for Tricare.
When a Tricare claim is processed, the Tricare computer contacts the DEERS computer automatically. It asks whether the person on the claim was eligible for Tricare on the date he or she received the medical service(s) on the claim. If DEERS replies “yes,” the claim will continue processing.
If DEERS replies “no” for any reason, the claim will be denied at that point, and the patient will be sent an explanation of benefits. The Tricare EOB always reports the reason any claim is denied and tells the patient of his/her right to appeal the decision. That reason for denial must be addressed in order for the claim to be paid.
If you receive medical care after you are married but before you are registered in DEERS, save copies of all itemized bills and receipts until your Tricare registration is complete and you have been issued a uniformed service identification card. Then you may file a claim for reimbursement of your costs. Your Tricare coverage will be retroactive to your first minute of eligibility.
What benefits can retiree’s new wife get?
December 19th, 2011 | TriCare Help | Posted by Military Times
I am a retired Marine. If I get married, is my new wife eligible for Tricare for Life if I enroll her in DEERS? What medical benefits will she get?
If you are entitled to receive retired pay, you are probably also entitled to Tricare. And, if you are entitled to Tricare, your wife will be entitled also, just as soon as you kiss the bride.
You will have to register her with DEERS and get her a military ID card before she can use Tricare, but that won’t take long to do. If you need instructions or other help for getting her on the program, please call the DEERS Support Office, toll-free, at 1-800-538-9552. That office can answer all your questions about Tricare eligibility and walk you through the registration process with your new wife.
You can enroll your wife in Tricare Standard, which is free, but she will have a $150 deductible every fiscal year and a copayment of 25 percent of the amount Tricare allows on each of her claims up to a total of $3,000 for the two of you.
Then there is Tricare Prime, which is not available everywhere. But, if you live in an area where you can get Prime, it’s the least expensive in terms of out-of-pocket costs. Prime, however, has a yearly enrollment fee of $260 per person, or $520 for a family of two or more people. Prime is also great because it gives you priority access to free care in military hospitals.
Finally, you mentioned Tricare for Life. That’s the best deal of all, and I get the idea you already know about it. If your new wife is entitled to Medicare and is enrolled in Part A and Part B, she is set for life Tricare for Life.
If you go to the Tricare web site, you can get official information about all Tricare plans and rules, including the free Tricare Pharmacy Program. Note: Do not enroll your wife in the Medicare Pharmacy Program, called Medicare Part D. She won’t need it, and it will block her from using the Tricare Mail Order Pharmacy Plan, which is a big money-saver. If she is already enrolled in Part D, she can call Medicare and cancel it.
What happens to daughter’s coverage when she gets married?
December 15th, 2011 | TriCare Help | Posted by Military Times
A Blue Cross Blue Shield subscriber has a daughter who is under 26 and married to a Navy man who has military coverage. Is the daughter eligible to have both coverages? If so, who is primary?
If the daughter is legally married to a man who is on active duty with one of the U.S. uniformed services, she is automatically eligible for Tricare. For her to use Tricare, however, the husband (her military sponsor) must contact his personnel office to arrange for her to be registered in the Defense Enrollment Eligibility Reporting System, better known as DEERS, and to be issued a uniformed service identification and privilege card.
Any Tricare eligibility through her status as daughter was terminated by law when she married. Whether she can retain her coverage under the father’s Blue Cross and Blue Shield plan is totally dependent on that plan’s eligibility rules. Tricare is not involved with that matter in any way.
For official information about the application of federal law to Tricare eligibility, please contact the DEERS Support Office, toll-free, at 1-800-538-9552.