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 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.
Does baby need father’s last name to get Tricare?
April 7th, 2011 | TriCare Help | Posted by Military Times
Q. I am pregnant. The baby’s father is in the military, but we are not together and we won’t be. Does the baby have to have his last name in order to get Tricare coverage?
The child of an active-duty, retired, or deceased member of the uniformed services is automatically legally eligible for Tricare. That is true regardless of whether the parents are legally married.
If you are legally married to the father, when the child is born, the father is responsible — in fact, required — to contact his Personnel Section to properly register the child in the Defense Enrollment Eligibility Reporting System (DEERS) and to complete all administrative actions required for the child to use his or her Tricare benefits.
If you are married to the father, you, also, are eligible for Tricare, provided you are properly enrolled in DEERS by your husband. He is required to enroll his family for all military benefits including Tricare.
If you are not legally married to the father when the child is born, it is the father’s responsibility to contact the Judge Advocate General (JAG) at his military facility to seek legal assistance for making the child eligible for Tricare. The JAG will provide the necessary guidance and help for him to do that.
Please note that the child, even if the parents are not married, is legally entitled to Tricare provided paternity can be established by court order. The father must take the actions needed to enroll him/her in DEERS.
For more information about this matter, please call the DEERS Support Office, toll-free, at 1-800-538-9552.
Can I get Tricare for unborn baby when the father isn’t helping?
March 3rd, 2011 | TriCare Help | Posted by Military Times
Q. The father of my unborn child was in the Army, but is now considered, from what he tells me, a disabled veteran. I was wondering if there is anything I can do to get benefits for my child, since the father does not want anything to do with the baby and is not helping me. Where do I begin?
I am not an attorney, and your problem may require one. If you cannot afford an attorney, I suggest that you contact your local Legal Aid Society or lawyer referral service. There, you may be able to get legal assistance at a reduced rate, or perhaps free.
As I understand the law regarding the matter, the illegitimate child of an active-duty, retired, or deceased member of one of the uniformed services may be determined to be eligible for Tricare if paternity is established by the order of a court. Additionally, the presumed father of the child must be shown to meet the legal requirements to be the sponsor of a Tricare beneficiary. There may be other legal requirements as well.
Again, I am not an attorney. Although I can tell you what a law says, I am not qualified to tell you what a law means or the way it applies to a given situation or person. For that information and help, consult an attorney.
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.
Need help finding a specialist Tricare will pay for
June 10th, 2010 | TriCare Help | Posted by Military Times
Q. I am covered by Tricare Standard (North Region) and my OB/GYN is referring me to Maternal Fetal Medicine because of a high-risk pregnancy. However, there are no MFM doctors within 40 miles who accept Tricare. If we go to an MFM in the area — we really have no choice if we want the child to make it – is there any way to get it covered, since it is medically necessary?
Unlike Tricare Prime, Tricare Standard provides coverage worldwide and does not require referrals for specialty care. It is required, however, that the provider must be a Tricare-authorized provider. An authorized provider is one who is registered with Tricare and has been approved to be paid for medical care rendered to Tricare’s beneficiaries. All health care insurers require some form of provider registration/certification.
Although federal law requires all medical services to be medically necessary and appropriate for the particular patient’s diagnosis, symptoms, and medical history, payment cannot be guaranteed simply because the services meet that standard and the provider is authorized. Tricare’s claims are evaluated for payment on a claim-by-claim basis.
Please call your Tricare North Region Service Center, Health Net Federal Services, toll-free, at 1-877-874-2273, to discuss your particular situation and to ask for help in locating an appropriate specialist.
If you feel that you do not get appropriate help, provide a detailed report of your medical situation and provider problems to the Tricare Headquarters, Tricare Management Activity, 16401 E. Centretech Parkway, Aurora, CO 80011-9043. Be sure to include your and your sponsor’s full names, his Social Security number, and a telephone number where you can be reached during the day.