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.
Covered by dad’s Tricare – and I’m pregnant
January 8th, 2010 | TriCare Help | Posted by Military Times
Q. My dad is retired and has Tricare Prime health insurance. I’m 20 years old and attending college, and I just found out I’m pregnant. Will the birth be covered under my parents’ insurance? And will the child be covered?
You need to call the Defense Enrollment Eligibility Reporting System (DEERS), toll-free, at 1-800-538-9552, to make sure your Dad properly enrolled you in Tricare, and you (because you are over 17 and an adult for Tricare legal purposes) have kept your military ID card and DEERS registration up-to-date.
If you are unmarried, Tricare eligibility will usually continue (by law) until midnight on the day before your 21st birthday. However, for as long as you are enrolled as a full-time student in good standing at an accredited university, your Tricare eligibility can be continued until midnight of the day before your 23rd birthday. Eligibility beyond age 21 is not automatic. You must make special arrangements. Ask DEERS for help.
So, first, call DEERS. If DEERS does not report that you are eligible for Tricare, ask what you need to do to re-establish your Tricare eligibility. While talking with DEERS, make sure all your other information is correct and up-to-date. Check the expiration date of your ID card. If it is within 90 days or so of expiring, ask DEERS how to renew it.
To use Tricare, your DEERS record and ID card both must be up-to-date. DEERS will help you with instructions for anything you need to do. Talk with DEERS about extending your eligibility after age 21. Get them to explain the matter of your full-time student status. Such as, if you drop out of school for a semester to have the baby, you will not be covered by Tricare during that time because you will not be a full-time student. Make sure you talk with DEERS about that situation and understand it thoroughly.
At any time when DEERS reports that you are eligible for Tricare, you are entitled to full Tricare benefits, including all maternity care. If DEERS says you are not eligible at any time, Tricare cannot pay for any medical care you get when DEERS does not say you are eligible.
You are eligible for Tricare because of your father’s military service. That benefit, however, does not extend to his grandchildren. The fact that you, the mother, are Tricare-eligible, does not make your baby eligible.
If the baby’s father is an active duty service member, or a military retiree, the baby can be made eligible, even if you are not married to him. Ask DEERS about it if that’s the case.
Be sure that you know what Tricare plan you are covered by. If you are enrolled in Tricare Standard, you may get care under Tricare anyplace in the world. If you are enrolled in Tricare Prime, you may use only certain doctors and hospitals. They are most likely only in the area where your father lives.
You have to make some decisions about where you will get all your maternity care and which Tricare plan to be enrolled in. If Tricare Prime is available where you live, you can have your Prime membership transferred, if that is the area where you will get your medical care.
You cannot easily get your prenatal care in one Prime service area and deliver in a different Prime service area. You can get your prenatal care in Prime area A and deliver in Prime area B only if you time it right and get your membership transferred in time. That is hard to do when you are in labor. Especially on a weekend or at 2 a.m. on Tuesday. Don’t count on being able to do it.
If you are enrolled in Tricare Prime, I suggest that you call your Tricare Prime Service Center and have a long talk with them to make sure you understand Tricare Prime’s rules about which providers you may use. You can incur a lot of unnecessary expense if you do not follow Prime’s rules exactly.
Also, changing doctors in mid-pregnancy may be a problem. It isn’t easy to find a doctor who will accept you as a new maternity patient after your first trimester.
I’m sure your Dad or Mom will want to be involved, and Dad will want to help you to resolve all your Tricare issues. Tricare, however, is not allowed to talk with him about your medical care unless you send Tricare a signed and dated letter with which you authorize them to talk with Dad and Mom (by name) or whomever you wish to authorize. Otherwise, Tricare cannot talk with another person about you. That is Privacy Act stuff. There is no getting around that law, not even for your Tricare sponsor.
If you have thought of having an abortion, Tricare is not allowed by federal law to cover it unless your life would be in danger if the pregnancy were to continue. That is a pretty powerful restriction and hard to prove.
You have a lot of things to learn and arrangements to make, and not a lot of time to do it, especially the decision about your maternity care doctor.
We’re not married – can I still get maternity care?
December 3rd, 2009 | TriCare Help | Posted by Military Times
Q. I’m a civilian but my boyfriend is in the Army. I’m pregnant and we were wondering, could I be covered under his insurance without us getting married? Just until the baby is born. I don’t know how the whole military insurance thing works.
Because you are not legally married to the baby’s father, you are not eligible for Tricare for any of your maternity care.
If you were married, you would be covered from the date of the marriage. You can confirm that by asking DEERS. Its toll-free telephone number is 1-800-538-9552. Everything you tell DEERS is completely confidential, and the information DEERS will give you is official.
I urge you to call DEERS now and talk with them about your eligibility question, especially as concerns the baby’s Tricare eligibility from the moment he is born. You need official information and help.
Because the father is on active duty, federal law makes the baby eligible for Tricare from the moment he is born. But, the father must do some things to get the baby signed up in Tricare because you and he are not married. The baby cannot use Tricare until he is properly signed up for the program. Talk with DEERS about that also.
Tell the father to go to the Legal Office (JAG Office) at his base and to talk with one of the Legal Officers (a military lawyer) about his baby’s Tricare coverage. He will need help to do the things that are necessary for the baby to get Tricare benefits for his medical care. That legal help will be free.
Tell the father about DEERS and give him the DEERS phone number. He should also talk with DEERS about the baby’s Tricare eligibility. Both you and the father need to know about those things so Tricare can help pay for any medical care the baby needs from birth, and for as long as the father is on active duty.
Tricare eligibility is established by federal law for designated categories of persons. Tricare does not have the authority to make individual eligibility determinations. Only the uniformed services have the authority to determine whether a particular person meets the legal conditions to be eligible for Tricare, to register an eligible person in DEERS, and to issue an appropriate identification card.
How can I make sure my son’s child – born out of wedlock – is covered?
October 30th, 2009 | TriCare Help | Posted by Military Times
Q. My son is currently deployed to Afghanistan. He will become a father in March or April. He is not married to the mother, but there is no question of paternity. I have his power of attorney, and I am trying to set up whatever is needed to secure benefits for his son when he is born. What needs to be done? Whom do I contact?
Those who wrote the law and regulation governing Tricare eligibility, fortunately, had the foresight to consider situations like your son’s. A uniformed service member’s child born out of wedlock may be declared eligible for Tricare if paternity is judicially determined. The child’s eligibility presumably begins at the moment of birth. But to the best of my knowledge, that does not confer any Tricare eligibility on the mother, not even for her maternity care.
Tricare Help has no official affiliation with the Defense Department, however. For official answers about eligibility, you must contact the the Defense Enrollment Eligibility Reporting System (DEERS) at 1-800-538-9552. DEERS is a federal agency under auspices of the Defense Department. All matters discussed with DEERS are protected by the federal Privacy Act of 1974. It maintains a computerized database of all Defense Department beneficiaries and the military benefits to which each is entitled by law.
Tricare itself does not have the authority to make individual eligibility determinations. Only the uniformed services have the authority to determine whether a given individual meets the legal criteria for Tricare eligibility, to register an eligible person in DEERS, and to issue a uniformed service identification card. DEERS will help you resolve the matter of the child’s Tricare eligibility. They can tell you what to do and whom to contact.