Preparing for a baby with Tricare...? — The Bump
Military Families

Preparing for a baby with Tricare...?

Can anyone give me a rundown of how putting a new baby on Tricare works? 

I want to learn more about what our options would be if we used Prime (where DH works doesn't have PCMs there), and I definitely want to check out where the baby's PCM would be located- I'm worried it would be at a base that's 40 minutes away without traffic. Would I know who the pediatrician would be before delivering? If not, what the heck pediatrician contact info do I give my civilian OB and hospital, which both ask for it before the baby's born? 

In your experience, does having kids on Prime make it easier when you move? We have GREAT civilian doctors around here, but we move when the baby's 6 months and I won't know where to until the month before I'm due (and my doctor & hospital want me to have a pediatrician lined up before then). 
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Re: Preparing for a baby with Tricare...?

  • Ok so I am assuming you are not on Prime right now? I am guessing you want to go on Prime after the delivery? 

    I delivered in a military hospital. After my DD was born we got her social security card (within a week) and then we could sign her up for Prime. You have to get the kid in DEERS before you can get them on the insurance. The whole process took right around two weeks. The military hospital had a Newborn Clinic that we took DD too before she had her official pediatrician (for weight check and BF issues). I don't know if you would be allowed to use the newborn clinic at the military hospital if you didn't deliver there. 

    Your best best best is to call Tricare and ask them your questions. You can also go online and put your zip code in and see where the closest pedi would be to your location. For instance, after DD was born we moved and her pedi ended up being about 30 min away. Now we live on post and it's like 2 minutes away. You generally have to go on post to a pediatric clinic if you are using Prime. It's been like that the past three post we've been stationed.

    As for it being easier, I don't think it is much different than getting a civilian doctor. Plus you're moving so you are going to have to change eventually. 

    You could probably tell the hospital that baby will be assigned to whatever pediatric clinic is on post after birth, but you won't know a specific doctor's name until baby is registered in DEERS and you have to have the baby's social security card for that.

    Sorry I don't feel like this was very helpful. 
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  • If you are on Standard when your baby is born, then the baby will be enrolled in Standard and you have 30 days to add the baby in DEERS and add them to Tricare. If you're Prime, it works the same way, but you have 30 days to add them to DEERS and Prime. Baby is covered from birth either way, retroactively to the day they were born.

    When my daughter was born we were able to enroll her in DEERS with the certificate of live birth from the hospital, they just needed the Social Security card within the 30 days to finalize her paperwork. Then it was just a call to Tricare the same day we started the DEERS enrollment. 

    FWIW, she was born at a duty station that didn't have a military treatment facility, so we were Prime but used civilian PCMs and hospital. So it worked like Standard in flexibility of providers, but had the Prime referral process and no co-pays. We were able to take our daughter to her pediatrician 3 days after she was born with no problem and we established that office officially as her PCM a couple weeks later. We didn't pay any out of pocket costs.
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  • @bacorrea Thanks! I'm Standard, and I'm going to stay on Standard after delivery. At least at this station we're pretty far from where I'd be seeing any Prime doctors, and they're constantly overloaded and taking weeks to months to see people. I've tried calling Tricare and gotten a bunch of different answers, most of which are "I think this is correct but I'm not sure, try this other number." I think I've spent 7-8 hours on the phone with them so far, hit my limit for now... 

    @babypi Thanks for the info! 
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  • So Prime Remote isn't an option for you?
  • @GhanimaAtreides nope, we're under the 50 mile limit. 
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