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.
Can girlfriend and baby be covered by Tricare?
January 13th, 2012 | TriCare Help | Posted by Military Times
My girlfriend and I recently had a baby. We are not married, but she is my beneficiary. Can I put her on Tricare Reserve Select with my daughter?
The requirements for Tricare eligibility are established by federal law and regulation. Because you are not legally married to the mother, she cannot become eligible for Tricare. That means her maternity care cannot be covered by Tricare.
The child’s situation is a different matter entirely. As your biological child, your baby daughter can be covered retroactively to the moment of birth.
To provide Tricare coverage for your daughter, there are certain actions you must take. To learn exactly what you must do, and for guidance in doing them, please call the DEERS Support Office, toll-free, at 1-800-538-9552. Be prepared to take notes of what you must do and how to do it. DEERS and your Personnel Office will walk you through the entire process.
Can girlfriend give birth in military hospital?
December 2nd, 2011 | TriCare Help | Posted by Military Times
I’m an active-duty soldier and my girlfriend and I are getting ready to have a baby. She doesn’t have health care at the moment. I know the baby can be covered as my dependent, but my question is, can she have the baby in a military hospital?
Whether your girlfriend can give birth at a military hospital does not fall under Tricare’s authority. Only your military hospital can decide. Contact the hospital’s Patient Administration Office for an official answer.
Of course, the problem is instantly resolved if you get married. She would be covered under Tricare.
The baby will be covered after birth either way, however. Call the DEERS Support Office, toll free, at 1-800-538-9552, to discuss that matter.
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.
If widow becomes pregnant, is maternity care covered?
August 3rd, 2011 | TriCare Help | Posted by Military Times
Q. My husband died on active duty in 2007. Our two sons and I use Tricare. I don’t plan on marrying for a couple of years, but what if I get pregnant? I know the baby, once born, wouldn’t be covered under Tricare, but would it cover my pregnancy, labor and delivery? Can I be penalized for it?
As the un-remarried widow of a deceased active duty uniformed service member, you are eligible for Tricare. Under present law, you will continue to be eligible for Tricare through your deceased sponsor for the reminder of your life, unless you marry again. If you remarry, your Tricare eligibility under that sponsorship will terminate at midnight of the day before your remarriage.
The above means that your maternity care can be covered by Tricare for as long as you remain eligible. There are no penalties of any kind. Your baby, however, will not be eligible for Tricare because he is not the child of your deceased sponsor.
In order for you and your present children to continue to use Tricare while you remain eligible, you must keep your DEERS registration and military identification cards up-to-date.
For official confirmation of the above, please call the DEERS Support Office, toll-free, at 1-800-538-9552.
Husband leaving active duty just a few weeks before baby is due
May 13th, 2011 | TriCare Help | Posted by Military Times
I have recently found out I am pregnant. My husband is active-duty military and he gets out October 22. My due date is November 3. I am trying to figure out if my entire pregnancy will be covered. I know that I will be covered until the 22nd, but what about after?
When your husband is discharged, you will lose all your health care benefits under Tricare at midnight of that day, although you are at term in your pregnancy. It is a matter of federal law.
Tricare does not have the authority to extend eligibility for any reason, even if you are in labor. (No, you would not be put out on the lawn to deliver, but there would be charges for your and the baby’s care after midnight on the date of your husband’s discharge.)
If longer care is needed, however, I believe the military hospital will make efforts to transfer you and the baby to a civilian hospital. That could present a problem because you will have no health insurance. You may want to discuss that possibility with the Patient Administration Office at your military hospital.
For confirmation of this information, or for answers to any questions you have regarding Tricare eligibility, please call the DEERS Support Office, toll-free, at 1-800-538-9552.
Your husband may be able to solve the problem with help from his Personnel Section. He might be able to extend his enlistment for a period long enough for your baby to be born and for you to receive any postnatal care that might be necessary. There is always a possibility, however remote, that some form of newborn care might be required also.
If your husband is unable to extend his enlistment, or if he chooses not to do so, there is an alternative.
There is a commercial health insurance plan created especially by the Defense Department for people who recently lost their Tricare eligibility for whatever reason. It is called the Continued Health Care Benefit Program (CHCBP). It provides coverage similar to Tricare Standard, but it can be purchased in short-term blocks of a few weeks at a time.
As it is a commercial health insurance plan, there is a premium charged for coverage. Because it provides benefits similar to the very broad coverage of Tricare Standard, it is not cheap: $988 per quarter for individual coverage, and $2,213 per quarter for family coverage.
You can learn more about CHCBP online, or by calling plan’s office, toll-free, at 1-800-444-5445.
Girlfriend is pregnant; will Tricare cover prenatal care?
May 3rd, 2011 | TriCare Help | Posted by Military Times
My girlfriend is pregnant. How do I get the baby covered by Tricare until it is born?
Your girlfriend cannot be eligible for Tricare unless she is married to you. Similarly, the baby cannot be eligible for Tricare until it is born. For official confirmation of these facts, please call DEERS, toll-free, at 1-800-538-9552.
If you and your girlfriend marry, she will become eligible for Tricare immediately. All her maternity care will be covered, starting on the day you are married. If you do not marry, however, the baby will still be covered by Tricare from the moment of birth.
Already pregnant and just getting Tricare; is my care covered?
February 17th, 2011 | TriCare Help | Posted by Military Times
Q. My husband is a 4th-year medical student under the Health Professions Scholarship Program. He receives health insurance through his med school, and I pay out of pocket for private insurance. In June, when he graduates and starts his residency in the Army, we are finally eligible for Tricare. However, we just found out we are expecting our first child, due around July. Will Tricare pay for the final medical care as well as labor and delivery, or will it be considered a pre-existing condition?
Tricare has no limitations or restrictions of any kind regarding pre-existing conditions. Thus, all your maternity care will be covered from your very first day of Tricare eligibility.
Contact the DEERS Support Office to learn the official date for the beginning of your Tricare eligibility. That toll-free number is 1-800-538-9552. DEERS also will help resolve any problems that could arise concerning your enrollment in the Program.
DEERS deals with eligibility issues only. DEERS cannot tell you anything about the Tricare program, its rules, its benefits, its claims, or its payments.
Please note that, although coverage is retroactive to your first day of legal eligibility, checks cannot be issued until your husband contacts his Personnel Section to officially register you with DEERS and with his uniformed service so you can be issued a uniformed service identification card.
That is administrative stuff having to do only with your use of Tricare, not with your eligibility for coverage. Once you are properly enrolled, any payments due since your first day of eligibility will be made retroactively.
Can I get coverage for pregnant granddaughter?
May 4th, 2010 | TriCare Help | Posted by Military Times
Q. Does Tricare cover expenses of pregnancy and childbirth for a dependent child? My wife and I are legal guardians of our granddaughter, who just turned eighteen, attends high school and is two months pregnant. Health insurance through my civilian employer has covered my granddaughter’s childhood health expenses, but pregnancy expenses, other than my wife’s, are excluded in the policy. The ID card facility informs me that my documentation is sufficient to enroll her in DEERS, but I hesitate to go through the bother if Tricare has similar exclusions.
Tricare eligibility is established by federal law for designated categories of persons. Tricare has no authority to make eligibility determinations. By law, only the services may determine whether a particular individual meets the legal criteria for Tricare eligibility, to register an eligible person in DEERS, and to issue an appropriate uniformed service identification card.
If you believe your granddaughter might be eligible for Tricare, it is not difficult to enroll her in the program.
Tricare has no limitations or exclusions for pre-existing conditions, and the entire maternity episode is covered from prenatal care through postnatal care.
Please note that your grandaughter’s baby probably will not be covered. You will want to discuss that with DEERS and any other health insurance.
Tricare Standard is the recommended plan for beneficiaries having other health insurance (OHI). Standard is free, and it will act as a supplement to the OHI, usually paying the things – such as the patient’s deductible and copayments – that the OHI does not pay.
By federal law, Tricare is required to always be last payer to all other health insurance. That is, beneficiaries with OHI must use that plan’s benefits first — file claims with the OHI first. When the OHI has paid its maximum, the beneficiary may file a Tricare claim for any unpaid balance.
The first thing to do is to determine whether your granddaughter is eligible for Tricare. Grandchildren are not usually eligible, but there are exceptions depending on the circumstances.
To begin the process, please call the DEERS Support Office, toll-free, at 1-800-538-9552. DEERS is a federal agency under the auspices of the Office of the Assistant Secretary of Defense for Health Affairs. All matters discussed with DEERS are confidential and protected by the Privacy Act.
DEERS is the official source for all information relating to Tricare eligibility including information, advice, and assistance with establishing program eligibility.
I suggest you talk with DEERS also about your entire family’s Tricare eligibility. All eligible family members must be properly registered in DEERS and be issued uniformed service identification cards in order to use the program. DEERS will explain the entire process to you and provide step-by-step guidance as needed at no cost. It can all be done by mail.
Go to the official Tricare website to review benefit information for Tricare Standard, Tricare Extra, and Tricare Prime. If you or your wife are nearing age 65 and Medicare entitlement, see also the plan called Tricare for Life. Make a permanent record, too, of contact information for your Regional Tricare Service Center.
For Medicare-eligible beneficiaries who are enrolled in both Medicare Part A and Part B, Tricare Standard will act as a free Medicare supplement, usually paying whatever Medicare does not pay. That will pay the balance on the Medicare claim and the provider’s bill in full.
It will also pay 75 percent of the amount it allows for Tricare-covered services that are not covered by Medicare (after satisfaction of the $150 fiscal year Tricare deductible).
Prime is not available in all areas, and your Regional Service Center can tell you whether it is available for persons living in your ZIP code. Tricare Extra is a special benefit category automatically associated with Tricare Standard and does not require special enrollment by persons enrolled in Tricare Standard.
You can also find information online about other Tricare benefits such as the Tricare Pharmacy Program, mental health care, and dental coverage.
Pregnant daughter will lose eligibility after her birthday – no matter what
March 25th, 2010 | TriCare Help | Posted by Military Times
Q. My unmarried daughter will turn 21 years old on June 18. She is pregnant, totally dependent on us, and lives with her father and me. Her Defense Enrollment Eligibility Reporting System record is up to date. The problem is that her doctor has counted the days and says she is due to deliver around the time of her birthday.
In a worst-case scenario, what would happen if she is in labor on her birthday? Will Tricare pay for the delivery that is already in process?
By federal law, your daughter’s Tricare eligibility will end, unfortunately, at 2400 hours on June 17, regardless of what else is going on at the time.
I told a father recently that if his son were in surgery at midnight, it is hypothetically possible that one stitch would be covered by Tricare, but when the clock strikes midnight, the next stitch would not. That’s just an imaginary example, of course, but it’s the way the law is written.
Midwives say that babies come when they are ready, regardless of what doctors say. Perhaps the baby will decide to be born a few days sooner than your daughter’s doctor expects. Medicine is not an exact science, and such miscalculations certainly are not unknown.
Good luck.