Military Families
Newborn and Tricare Standard
I am due in 9 days and can not figure out Tricare Standard coverage for my newborn. How long do I have to enroll my LO in DEERS to be covered with Tricare Standard?
This discussion has been closed.
Re: Newborn and Tricare Standard
Your baby will automatically be covered under Tricare Prime for the first 60 days of life.
If you do nothing, your baby will continue to be covered under Tricare standard for the rest of his/her first year of life.
However, you should enroll your baby in DEERS within that time period (you will have to have the baby's birth certificate and social security number to complete the enrollment, so it could take a few weeks).
After the baby is enrolled in DEERS you can choose whether you want to keep him/her on Prime, or whether you want to switch to Standard. If you want to keep him/her on Prime, you will have to go to the Tricare office on your base/post and fill out the enrollment paperwork before the first 60 days are up. If you want the baby to be on Standard you can switch at the Tricare office or wait out the 60 days until his/her coverage automatically switches to Standard.
If my LO is automatically enrolled in Prime...do I have to go to a base dr or can I still choose my dr?
::headdesk::
NOT TRUE. Please, for the love of God, do your research before answering questions.
From the Tricare Website:
If any family member is enrolled in Prime, TRICARE Prime covers the following:Newborns for 60 days beginning from the date of birth;Adopted children for 60 days beginning from the effective date of the actual adoption; andPre-adoptive children for 60 days beginning on the date of placement of the court or approved adoption agency.To continue Prime coverage past the first 60 days, you must enroll your newborn or adoptee in either TRICARE Prime or TRICARE Prime Remote within the 60-day window. On the 61st day and after, if your child isn't enrolled, TRICARE processes all future claims under TRICARE Standard and Extra (higher costs) until your child is enrolled.
https://www.tricare.mil/mybenefit/home/overview/Eligibility/DEERS/Children?country=United+States&zipCode=32065&plan=TRICARE+Prime&status=Active+Duty+Family+Member
OP: You can use any in-network doctor for the first 60 days. The Tricare website or your Tricare office can provide you with a list of in-network providers. After 60 days if you want to continue using a civilian provider, you will have to make sure LO is covered under Standard.
The sponsor always has to be present unless you have a specific POA for amending his/her DEERS profile.
The 60 days is a Tricare policy. I wonder why your base doesn't honor it. I know overseas stations allow a longer period to compensate for the added difficulty of obtaining the necessary documents from abroad. I'm curious why a CONUS base would have stricter policies than Tricare as a whole.
I assumed the sponsor would need to be present, I just wanted to make sure the OP was aware in case they didn't know. Better to have someone remind them, than to have her show up without him and be turned away, was what I was thinking.
As to the 30 days vs 60, I'm not sure why my base is says 30, but that's what they told us at our Tricare maternity benefits meeting, and it's what's in the maternity handbook they gave us when we confirmed the pregnancy. I double checked the handbook before I posted, just to make sure I'd remembered right. I wonder if it has anything to do with our base hospital not being set up for delivery, so all babies are born off base; perhaps a need for quicker information since Tricare is dealing almost exclusively with civilian hospitals for deliveries? I honestly have no clue why there is a difference in policy.
So the standard for Tricare is 60 days, but it sounds like a few bases may have a shorter time frame policy for some reason, so it really couldn't hurt to visit the local Tricare benefits office to make sure you're aware of exactly what you need to do and when, OP. You definitely do not want to get charged for anything simply because you weren't aware of a necessary policy.
Tricare itself does not differ based on where you are. The information I'm providing is from Tricare itself, as is clearly published on their website. If your particular base's policies are different, that's a whole other story. I have not lived at every base and I don't pretend to know the individual policies of each base. The information I'm provide is about Tricare, not your base.
Actually TRICARE does not differ where you are. While a Base can make individual policies for how THEY manage their individual care (with in reason, they cannot break any of the federally mandated laws) they can not do things like over ride the DOD DEERS system. That computer system is specifically programmed to allow any baby born to any parent (adopted as well) who is enrolled in Prime to be covered through the Prime option from the date of birth through 60 days.
https://dcp.psc.gov/ccbulletin/articles/DEERS.htm
***From the *** DEERS site directly. The MTF is not supposed to ignore what it's own bosses say.
The computer system, that all medical bills are run against, will approve any care through PRIME for those first 60 days. basically, YOUR MTF is being diengenuous.
https://www.tricare.mil/mybenefit/ProfileFilter.do?puri=/home/overview/Eligibility/DEERS/Children***From the *** TRICARE website. Again the MTF is not allowed to go against a policy like this
If your MTF is not following the TRICARE rules/regulations, then you need to make a complaint to the Patient Advocate and the TRICARE Rep at the TRICARE Office on base.
But please do not get pissy with Mel for providing you with the correct information.
Oh and I worked directly for TRICARE in their SKYLINE offices in DC and have testified in front of congress regarding Standard and Prime. And while I have been out of the business for 6 years, there are some things that have not chaned.
It should be 60 days. Since other ladies were told differently by their post, I would ask your FRG leader or FRSA to see if they know the answer since you are having issues getting in touch with your DEERS office.
Before we left the hospital, I asked for a certificate saying a birth certificate and SS had been filed for our babies. I then took that to the SS office for another paper from them. The DEERS office accepted that to enter them into the system. We just had to bring the official forms up there when we got them later. We did that all with in a few days of birth.
Pissy? LMFAO if you think that's me getting mean then you and your little friend have very thin skin. If anyone was being pissy it was your friend for going off on someone for putting information out that actually isn't wrong since it happens obviously at more than 1 base.
And I'm sorry but I think I'm going to trust the Tri Care office on my base, the tri care representative at the hospital, and the people that work at PSD with the deers system over what you have to say. I just went through this process last week so I think I know how it works on MY base.
Do you have a reading comprehension problem? The information I provided came directly from the TRICARE website.
You know the organization that
But if you are still thinking that your lowly MTF (and we all know that a Base could never be wrong) has the bead on the current information and the TRICARE Website is blowing smoke, I will happily provide you with as many different sources of the information I rely on (given I actually have been around the military long enough to know what really happens in the military).
This is the Public Health Services website. And for some of you, who have only been married into the military for a year or so, PHS is one of the 7 Uniformed Services, ie they have the know.
https://dcp.psc.gov/ccbulletin/articles/DEERS.htm
Newborn Enrollment in DEERS
As a parent of a newborn infant, one of the first decisions you probably made, was deciding on a name for your newborn son or daughter. As a beneficiary of the Department of Defense Military Health System, the second and most important decision you can make is to enroll your newborn infant in the Defense Enrollment Eligibility Reporting System (DEERS) as soon as possible after birth.
Why Enrolling Your Newborn in DEERS Is Important
By enrolling your newborn in DEERS, you establish TRICARE eligibility for the infant and avoid potential claims problems or other financial hardships for your family in the future. As a new parent, enrolling your baby in DEERS provides you the comfort of knowing your baby will remain TRICARE eligible and able to receive the essential well baby and pediatric health care he or she needs.
Aren't Newborns Already TRICARE Eligible?
A newborn infant is covered as a TRICARE Prime beneficiary in DEERS for the first 60 days after birth -- as long as one additional family member is enrolled in TRICARE Prime or TRICARE Prime Remote. After the initial 60 days, any claim submitted for a newborn will process as TRICARE Standard until the infant is enrolled in DEERS and TRICARE Prime, or the infant's TRICARE Standard eligibility ends. Eligibility for TRICARE Standard benefits ends 365 days after birth for any newborn infant who is not enrolled in DEERS.
How to Establish TRICARE Eligibility for a Newborn in DEERS
Parents and legal guardians must enroll their newborn child in DEERS as soon as possible after birth. To establish a newborn's TRICARE eligibility in DEERS, you must:
Submit a certificate of "live birth?, in person, to the nearest military ID card facility. Or, you may mail a copy of the birth certificate and a notarized DD Form 1172, ?Application for Uniformed Services Identification and Privilege Card,? signed by the sponsor to the following address: Office of Commissioned Corps Operations, ATTN: Division of Commissioned Corps Officer Support, Suite 100, Plaza Level, 1101 Wootton Parkway, Rockville, MD 20852.
Apply for your child's Social Security number. Go to the Social Security Administration Web site, https://www.ssa.gov or call 800-772-1213 for an application.
Once you receive your child's Social Security number, go to your nearest identification (ID) card-issuing facility to update their information in DEERS. Or, you may mail a copy of the ?Social Security card and the DD Form 1172 to the address listed above. If the Social Security number is not provided within 90 days of the child?s initial entry into DEERS, Direct Care benefits will be suspended.
Any changes that impact family status must be reported to DEERS. Family status changes include marriage, divorce, or new child. Because DEERS enrollment is directly tied to TRICARE eligibility, care may be denied if the sponsor and family members are not enrolled in DEERS.
For additional information on enrolling a newborn baby in DEERS, parents or guardians may contact or visit the nearest military personnel office, ID card-issuing facility, or contact the Defense Manpower Data Center Support Office (DSO) telephone center at 800-538-9552. A list of military ID card facilities is available at https://www.dmdc.osd.mil/rsl/owa/home. Additional information on DEERS eligibility is available on the TRICARE Web site at https://www.tricare.osd.mil/deers/default.cfm.
*See also: TRICARE: The Basics Fact Sheet
TRICARE Eligibility Fact Sheet
Defense Enrollment Eligiblity Reporting System Fact Sheet
Here we go - the US Coast Guard.
ttp://www.uscg.mil/basedetStLouis/Overview.pdf
Defense Enrollment Eligibility Reporting System (DEERS) Newborns, Adopted Children and Pre-Adoptive Children It's important to enroll newborns and adopted children in the Defense Enrollment Eligibility Reporting System (DEERS) to establish TRICARE eligibility for essential well-baby and pediatric health care. By enrolling your newborn or adopted child in DEERS, you may avoid potential claims problems. Enrollment in DEERS is a separate step required before you can enroll in any of the TRICARE program options such as TRICARE Prime, TRICARE Prime Remote for Active Duty Family Members or TRICARE Reserve Select. Learn more about TRICARE eligibility for children. To establish a newly-born, adopted or pre-adoptive child's TRICARE eligibility in DEERS, you must submit the following to and ID card office: An original or certified-copy of a birth certificate or certificate of live birth (signed by the attending physician or other responsible person from a U.S. hospital or military treatment facility), or consular report of birth (FS-240) for children overseas; A record of adoption or a letter of placement of the child into the home by a recognized placement/adoption agency or the court before the final adoption; and An Application for Department of Defense Common Access Card and DEERS Enrollment (DD Form 1172) signed by the sponsor and verifying official from a uniformed services identification (ID) card-issuing facility. If the sponsor has not legally established the children's relationship, the parent should contact the nearest uniformed services personnel office for help in determining DEERS eligibility. It's important for you to apply for your child's Social Security number by visiting the Social Security Administration Web site, or by calling 1-800-772-1213. Once you receive your child's Social Security number, be sure to go to your nearest ID card office to update their DEERS information. As long as another family member is enrolled in Prime, TRICARE Prime covers newborns for 60 daysHere is something from the Army National Guard
https://myarmybenefits.us.army.mil/Home/Benefit_Library/Federal_Benefits_Page/TRICARE_Prime.html?serv=149
Army National Guard: Federal Active Duty
Benefit Fact Sheet
Summary:
TRICARE Prime is a managed-care health insurance option available to all eligible military beneficiaries that are not entitled to Medicare (are age 65 or older) in Prime Service Areas of the North, South, and West Regions of TRICARE.
Eligibility:
Army National Guard Soldiers are eligible for TRICARE Prime while on federal active duty and while on travel to and from home and duty station. Authorized family members of Army National Guard Soldiers are eligible for TRICARE and may elect to utilize TRICARE Prime when:
Family members may choose TRICARE Prime, TRICARE Prime Remote, TRICARE Standard, or TRICARE Extra.
TRICARE benefits information changes frequently so be sure to check https://www.tricare.mil/mybenefit/home/overview/LearnAboutPlansAndCosts/TRICAREPrime for updates.
Newborn babies and newly adopted children are covered under Prime for the first 60 days. After 60 days, they must be properly registered in Defense Enrollment Eligibility Reporting System (DEERS) and formally enrolled in Prime in order to receive Prime coverage.
TRICARE covers eligible children until age 21. For TRICARE coverage beyond the age of 21, college students must be enrolled full-time at an accredited institution of higher education and the sponsor must provide more than 50 percent of the student's financial support up to the age of 23.
The National Defense Authorization Act (NDAA) FY 2011 gave the DoD the authority to expand benefits to qualified dependents that lose TRICARE eligibility and are under the age of 26. Young adults can purchase TRICARE Young Adult and pay monthly premiums.
Un-remarried former spouses of eligible Soldiers may be eligible for Prime; however, the individual must first establish his/her eligibility for health care coverage by verifying registration in DEERS under his/her own social security number. Completing DD Form 2876 is required to enroll in TRICARE Prime under the former spouse's SSN; otherwise, the former spouse will be covered under TRICARE Standard and TRICARE Extra. The former spouse must have been married to the same member or former member for at least 20 years, and at least 20 of those years must have been creditable in determining the member's eligibility for retirement pay with coverage beginning after the date of divorce, dissolution or annulment OR the former spouse must have been married for at least 20 years, and at least 15 - but less than 20 - of those married years must have been creditable in determining the member's eligibility for retirement with coverage for only one year from the date of the divorce, dissolution, or annulment.
When an active duty sponsor dies, surviving spouses remain eligible for TRICARE health care benefits as active duty Family members for a three-year period. At the end of the three-year period, TRICARE eligibility continues, but the survivor's status changes to that of retiree Family member. It is important for the survivor to update personal information and to keep supporting documents current in DEERS. Surviving children whose sponsor died on or after October 7, 2001, remain eligible for TRICARE benefits. Unlike spouses, eligibility will not change after three years, and children remain covered until eligibility ends due to the age limits or another reason (e.g. marriage).
Here is something from the Marines (and the Navy, given the USMC falls under the Navy Surgeon General - that 3 start who works at TRICARE)
https://www.marines.mil/unit/mcrc/9mcd/Documents/FRO/Upcoming%20Events/Newborn.pdf
Newborn Policy: Your newborn or new adopted child will be automatically covered under TRICARE Prime/ Prime Remote for Active Duty Family Members (TPRADFM) for 60 days after the date of birth and/or adoption.
Parents/legal guardians should get their newborns registered in DEERS within 60 days of birth to establish eligibility for health care coverage.
Within this 60 day window, you should: ? Register your newborn or newly adopted child in DEERS ? Enroll your newborn or newly adopted child in TRICARE Prime or TRICARE Prime Remote for Active Duty Family Members if you wish to continue the Prime benefit coverage. ? NOTE: To ensure that you newborn and/or adopted child is covered, it?s a TWO step process to have them covered under that Military Medical Program - TRICARE Failure to enroll your child in TRICARE Prime/TPRADFM will result in TRICARE Standard coverage for your child for up to 365 days. If not enrolled in DEERS within 365 days, your child loses all TRICARE eligibility. Registering Your Child In DEERS: A certificate of live birth (issued by the birthing facility) and a sponsor-signed DD Form 1172 are required to get a newborn registered in DEERS. If a sponsor is unable to be present when a newborn is registered in DEERS, the sponsor's signature on the DD Form 1172 must be notarized. Present these documents at the nearest ID card facility (visit www.dmdc.osd.mil/rsl/) or unit personnel office. Families can also get assistance by calling the Defense Manpower Data Center Support Office (DSO) Telephone Center at 1-800-538-9552 or for the Deaf (TTY/TDD): 1-866-363-2883. Hours of Operation: Monday through Friday, 6 a.m. to 3:30 p.m. (Pacific time), except Federal holidays. Enrolling Your Newborn or Newly Adopted Child in TRICARE Prime/TPRADFM Newborns are covered as TRICARE Prime beneficiaries for 60 days after birth, as long as one person in the family is enrolled in TRICARE Prime, then... ? TRICARE Prime or TPRADFM benefits end after 60 days, and future claims will process as TRICARE Standard (higher costs) until 365 days after the child's birth. On day 366, DEERS will show "loss of eligibility," and the child will no longer be able to receive TRICARE benefits. ? If a family wants to continue TRICARE Prime/TPRADFM coverage after the first 60 days following birth or adoption, the family must submit a TRICARE Prime enrollment application before the 20th of the current month to allow coverage to begin the 1st of the next month. (e.g., if an enrollment application is received August 20th, coverage begins September 1st). ? If the enrollment application is received after the 20th of the current month, coverage is not effective until the 1st of the second month (e.g., if enrollment application is received after August 21st, coverage begins October 1st, not September 1st). A Special Note for Newborns or Newly Adopted Children Overseas TRICARE officials in overseas locations are authorized to extend the period of coverage-without-enrollment, up to 120 days, on a case by case or regional basis. For more information, please see Newborn enrollment flyer. This link will take you to the TRICARE site to explain more about the benefits by registering your child in D.E.E.R.S. and enrolling your child into TRICARE. ***This one has the 60 day period three times.Finally, the US Air Force from the US Air Force's official website.
https://www.af.mil/news/story.asp?id=123259918
by Linwood Outlaw III
TRICARE Management Activity
6/14/2011 - FALLS CHURCH, Va. (AFNS) -- TRICARE offers a variety of health plans designed to provide the best quality of care for parents and their babies.
However, if children are not properly registered in the Defense Enrollment Eligibility Reporting System, they risk losing their TRICARE benefits, program officials said.
"TRICARE Management Activity provides the best health care possible to support your newborn's needs," said James Frank, the DEERS in-process review program manager. "All you need to do is register your child in DEERS as soon as possible and the benefit process will work as planned."
Newborns and adopted children must be registered in DEERS before they can be enrolled in any TRICARE health plans. Parents do not need to know their child's social security number to complete the registration process, but they need to add the number in DEERS when it becomes available. Parents can apply for their newborn's social security number at www.ssa.gov or by calling 800-772-1213 begin_of_the_skype_highlighting 800-772-1213 end_of_the_skype_highlighting.
To register their child in DEERS, parents must submit the following documents to their local identification card office:
-- An original or certified copy of the baby's birth certificate or certificate of live birth, or an FS-240 consular report of birth for children who are overseas
-- A record of adoption or a letter of placement of the child into the home by a recognized placement/adoption agency or the court before the final adoption
-- A DOD Form 1172-2, application for ID card/DEERS enrollment, signed by the sponsor and a verifying official from a uniformed services ID card-issuing facility. If the sponsor can't sign the DOD Form 1172-2 in person at an ID card facility, then a notarized copy of the document is required.
If children are not enrolled in TRICARE Prime within 60 days after their birth, they are automatically covered under TRICARE Standard and Extra until a full year after their birth. If parents do not register their child in DEERS within one year of birth, the child loses eligibility and cannot receive TRICARE benefits until he or she has been registered. To find the nearest ID card office, parents can visit the real-time automated personnel identification system, or RAPIDS, site locator website at www.dmdc.osd.mil/rsl/.
Children are covered under TRICARE Prime for 60 days after their birth if at least one family member is enrolled. Parents should submit an enrollment application to their regional contractor within 60 days of the child's birth so the child remains eligible for Prime benefits beyond the initial coverage period. Adopted children are covered under Prime for 60 days beginning from the effective date of the actual adoption. Pre-adoptive children are covered by Prime for 60 days beginning on the date of placement of the court or an approved adoption agency.
The enrollment period for the TRICARE Overseas Program and TRICARE Prime Remote is extended to 120 days so that parents who live abroad can have ample time to satisfy overseas eligibility requirements for newborns. Once a child is registered in DEERS, the parent should have no problem getting health care for their newborn. For more information about DEERS, visit www.tricare.osd.mil/deers.
MilitaryOneSource - https://www.militaryonesource.mil/MOS/f?p=MOS:CONTENT:0::::SV,UT,LG,CID,TID,SID,XID,COHE,MTYPE:Army%20Active,Member,En,23.50.10.0.0.0.0.0.0,23.50.10.10.0.0.0.0.0,23.50.10.10.50.10.40.0.0,23.50.10.10.50.10.0.0.0,261694,Articles
At home with the baby
Many new parents are struck by how much they've prepared for the birth, but how little they know about what to do with a baby once they're home. These suggestions can help:
You can look at this exchange as one Military Spouse being condescending with another one. Or you can look at it for what is really is, one Military Spouse giving her knowledge and wisdom gained through years of experience.
That is the whole point of this site - to help sort through the mis-information that is born of ignorance, misunderstanding and outright disregard for the rules (as is happening at your MTF).
You are going to find that this occurrs all of the time, and not just in Health Care (look at the post about COLA and extra pays). And unless you have the correct information you will be railroaded time and time again. If you want a healthy and happy career as a military spouse, you are going to have to figure out what you are going to do when come upon these situations.
I wish you luck.
::slow clap::
I
you.
Meltoine and Ilumine, I'm not trying to start/participate in a heated discussion, I swear, but I do have a question for either or both of you, and you both seem to know the regs extremely well.
Since I was curious, and just to confirm what Ilumine had quoted, I called Tricare South to verify that it was 60 days to register the LO in DEERS before Tricare would switch to Standard. I mentioned that my hospital and Tricare Benefits staff both handed out booklets and paperwork with a 30 day deadline for DEERS enrollment and asked if there was any official reason at all why they would be doing that, and the Tricare South rep had no explanation, but she did reassure me that it is 60 days according to Tricare.
So, my question is, what steps - if any - would you suggest be taken at this point? Should I bring it up to someone so that the hospital/local Tricare Benefits staff can correct the misinformation they're handing out, and if so, who?
Chances are the difference in deadlines won't matter to DH and I personally, because we'll probably be trying to get the LO enrolled as quickly as possible just so it is taken care of, but I could see how it might become an issue for someone else since I know they are giving incorrect information to expecting parents in multiple ways (benefits meetings, MTB lectures, pamphlets and books).
First and foremost, print out the TRICARE page we provided. Ensure that it's a full picture of the site. I would print out a couple others just for shitsandgiggles
Second, go into the TRICARE Service Center with the ask for the Supervisor. Politely explain the situation and ask him/her what He/she thinks is the best way to approach the misinformation being spread.
Yep, start out being nice and incorporating their assistance. It always throws the, for a loop.
Then, head on over to the MTF Patient Advocate and present her with the facts and again, ask him/her what he/she thinks is the best approach in getting the MTF on track.
Along the way, grab an ICE Survey and write it up.
For all encounters, specifically ask that they contact you with their solutions and end result, since you are going to need to use them in the future.
I know that this sounds like a lot of work, but the reality is, the base is breaking wth a protocol/policy and they KNOW that they are doing so. Unless you play a little hardball, they will sweep ths under the rug.
If you don't get a satisfactory response , then you contact your First Shirt with your concerns and ask him/her for help.
If they still ignore you, then you come back here and I will give you the contact information to a couple of the Military Association Reps who just LOVE to take on these issues.