Holy Tricare...WTH do I do now? — The Bump
Military Families

Holy Tricare...WTH do I do now?

So, I just got the paperwork. DH recently left for BT. And I have no idea where to go or what to do. I have sooooo much to learn. I guess my first question is, how do I know which Tricare plan we are enrolled in? Do I learn that info when I go get my ID? DH always handles this sort of thing, and I am clueless when it comes to insurance anything. (Prior to being married, I was on my paren't insurance, so they dealt with all of it.)

TIA for any insight/help you all can give and for taking the time to help a newbie army wife out. :o)

Re: Holy Tricare...WTH do I do now?

  • You will be automatically enrolled in Tricare Standard as soon as your H lists you as a his spouse in DEERS (his electronic personnel file). If you want, you have the option to enroll in Tricare Prime.

     Tricare Standard allows you to see a wide variety of in-network civilian healthcare providers. You may also be seen on post by military doctors, but you will be given lower priority than people enrolled in Prime, so it may take longer to get an appointment or they may say that they are unable to accept patients on Standard at this time. When you see a civilian provider, you will pay a cost share (copay) for most visits and procedures. The amount depends on what services you get, but you can find out what the cost will be by asking your doctor's billing manager or the Tricare representative on your post. 

    Tricare Prime allows you priority to see military doctors on post. You may be referred to civilian providers if the doctors on post are booked up, or if you need to see a specialist that isn't available at your post. For the most part, though, you will be seen on post my military doctors. You pay no co-pays.

    For your sig, it looks like you are TTC. Maternity care is 100% covered under both plans with no cost shares. On Standard, however, you will pay a small hospital fee. I think it's $16.75/day for your hospital stay when you deliver (if you deliver in hospital). There are also ways to get birth centers and homebirth covered if you want to go that route. If you're interested in that I can give you more information specific to your location.

    Regular eye exams are covered under both plans. Glasses and contacts are not. If you need them, you will pay out of pocket for these for yourself. Glasses and contacts for YH will, however, be covered.

    Dental insurance is separate from Tricare. It's provided through MetLife for a small monthly fee. I think it's about $12. You get 2 cleanings per year, 3 in any year you are pregnant. Services beyond regular cleanings usually involve a co-pay, but this varies by the service. The MetLife website and your Tricare Rep can give you more information. 

    To enroll in Tricare Prime, you have to fill out and submit paperwork to the Tricare Rep on post. Your coverage will be effective at the beginning of the next month. If you choose to stay on Tricare Standard, you don't have to do anything. You also have to fill out enrollment paperwork for the MetLife dental insurance. You also have to enroll in that program and your coverage will be effective at the beginning of the next month.

    Some people like Standard because they have more options for care providers. The downside is that you pay more because there are co-pays for most things.

    Most people I know use Prime because of the convenience of being seen on post and that it's "free".  


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  • This is also covered in the FAQs at the top of the board.
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  • imagemeltoine:

     

    Regular eye exams are covered under both plans. Glasses and contacts are not. If you need them, you will pay out of pocket for these for yourself. Glasses and contacts for YH will, however, be covered.

     

    I haven't found this to be true. I have tricare standard and had to pay for my eye exam. I was told that standard only covers it if you have reached your catastrophic cap for the year. I'm not trying to argue, just sharing my experience. 

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  • imagejessilynnwilliams:
    imagemeltoine:

     

    Regular eye exams are covered under both plans. Glasses and contacts are not. If you need them, you will pay out of pocket for these for yourself. Glasses and contacts for YH will, however, be covered.

     

    I haven't found this to be true. I have tricare standard and had to pay for my eye exam. I was told that standard only covers it if you have reached your catastrophic cap for the year. I'm not trying to argue, just sharing my experience. 

    They cover one exam per year. They do not cover the exam for contact fittings. Maybe that's what's happening? 
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  • imagemeltoine:

    You will be automatically enrolled in Tricare Standard as soon as your H lists you as a his spouse in DEERS (his electronic personnel file). If you want, you have the option to enroll in Tricare Prime.

     


     

    I've found this to not be true, I have met a wife who didn't realize she had no insurance coverage when she went to get fertility treatment because the personel on his ship said they would automatically enroll her when she was added to his Page 2, but she wasn't, and didn't have coverage

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  • LyseeHLyseeH member
    imageFutureMrsTowns:
    imagemeltoine:

    You will be automatically enrolled in Tricare Standard as soon as your H lists you as a his spouse in DEERS (his electronic personnel file). If you want, you have the option to enroll in Tricare Prime.

     


     

    I've found this to not be true, I have met a wife who didn't realize she had no insurance coverage when she went to get fertility treatment because the personel on his ship said they would automatically enroll her when she was added to his Page 2, but she wasn't, and didn't have coverage

     

    once we were enrolled in deers we had to go down to the tricare office and enroll there, also remember that dental is also seperate! i believe its called united concordia (i can never remember) but we did that online because we forgot about it in the first place! I was enrolled directly into tricare prime the way we did it, but our daughter is standard.

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  • imageFutureMrsTowns:
    imagemeltoine:

    You will be automatically enrolled in Tricare Standard as soon as your H lists you as a his spouse in DEERS (his electronic personnel file). If you want, you have the option to enroll in Tricare Prime.

     


     

    I've found this to not be true, I have met a wife who didn't realize she had no insurance coverage when she went to get fertility treatment because the personel on his ship said they would automatically enroll her when she was added to his Page 2, but she wasn't, and didn't have coverage

    Agree.  You are not automatically enrolled.  You and DH or just DH have to get you enrolled in DEERS, which MIGHT automatically enroll you in tricare but I'd definitely double check that you are enrolled.  We got married 6 years ago so I don't remember how it worked, and it may have changed.  Also, once your baby is born you need to enroll LO in DEERS and Tricare. 

    Extra tip:  Make sure DH fills out the paperwork to have one more dependent.  That is not automatic, and several of our military friends have missed out on extra pay from having another dependent in the family because they were never told to add the new baby. 

  • imageLemonLover33:
    imagejessilynnwilliams:
    imagemeltoine:

     

    Regular eye exams are covered under both plans. Glasses and contacts are not. If you need them, you will pay out of pocket for these for yourself. Glasses and contacts for YH will, however, be covered.

     

    I haven't found this to be true. I have tricare standard and had to pay for my eye exam. I was told that standard only covers it if you have reached your catastrophic cap for the year. I'm not trying to argue, just sharing my experience. 

    They cover one exam per year. They do not cover the exam for contact fittings. Maybe that's what's happening? 

    I don't wear contacts... I think I got ripped off! lol 

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  • imageFutureMrsTowns:
    imagemeltoine:

    You will be automatically enrolled in Tricare Standard as soon as your H lists you as a his spouse in DEERS (his electronic personnel file). If you want, you have the option to enroll in Tricare Prime.

    I've found this to not be true, I have met a wife who didn't realize she had no insurance coverage when she went to get fertility treatment because the personel on his ship said they would automatically enroll her when she was added to his Page 2, but she wasn't, and didn't have coverage

    There will always be times when the system doesn't work properly, and of course you should double check, but you should be enrolled in Standard automatically upon being listed as a dependent in DEERS. And even if this does happen to you and you get billed for a visit or procedure when you should have been covered, Tricare will make your coverage effective retroactively and pay the bill. You won't be stuck with it. 

     

    imageLyseeH:
    once we were enrolled in deers we had to go down to the tricare office and enroll there, also remember that dental is also seperate! i believe its called united concordia (i can never remember) but we did that online because we forgot about it in the first place! I was enrolled directly into tricare prime the way we did it, but our daughter is standard.
    You were already enrolled in Standard. At the office, you enrolled in Prime. Dental is separate, that's why I devoted separate paragraphs to it. It's not United Concordia anymore. Their contract expired in May. Dental insurance is now through MetLife. Every beneficiary got several letters explaining this and new insurance cards in the mail months ago. If you didn't, I highly suggest calling and making sure you're enrollment was transferred properly.
    imageDawnJM25:

    Extra tip:  Make sure DH fills out the paperwork to have one more dependent.  That is not automatic, and several of our military friends have missed out on extra pay from having another dependent in the family because they were never told to add the new baby. 

    "Several" of your military friends are wrong. You don't get any extra pay for having a baby. The number of dependents a service member has has no bearing on their base pay or incentive pay. BAH (housing allowance) is higher for SMs with dependents, but it does not change when you add additional dependents. Married SMs get dependent rate BAH because they have 1 dependent (the spouse). A SM with 10 kids gets the same dependent rate BAH. IT DOES NOT INCREASE WITH MORE DEPENDENTS.
    You do have to enroll and new children (bio or adopted) into DEERS. Children are automatically covered under Prime for the first 60 days after birth or adoption. During this time, you should enroll your child in DEERS and choose whether you want him/her covered under Prime or Standard, and adjust your coverage at the Tricare office accordingly.
     
    For the love of all things holy, please read the FAQs on this board and/or your Tricare handbook before answering questions.  
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  • imagemeltoine:
    imageFutureMrsTowns:
    imagemeltoine:

    You will be automatically enrolled in Tricare Standard as soon as your H lists you as a his spouse in DEERS (his electronic personnel file). If you want, you have the option to enroll in Tricare Prime.

    I've found this to not be true, I have met a wife who didn't realize she had no insurance coverage when she went to get fertility treatment because the personel on his ship said they would automatically enroll her when she was added to his Page 2, but she wasn't, and didn't have coverage

    There will always be times when the system doesn't work properly, and of course you should double check, but you should be enrolled in Standard automatically upon being listed as a dependent in DEERS. And even if this does happen to you and you get billed for a visit or procedure when you should have been covered, Tricare will make your coverage effective retroactively and pay the bill. You won't be stuck with it. 

     

    imageLyseeH:
    once we were enrolled in deers we had to go down to the tricare office and enroll there, also remember that dental is also seperate! i believe its called united concordia (i can never remember) but we did that online because we forgot about it in the first place! I was enrolled directly into tricare prime the way we did it, but our daughter is standard.
    You were already enrolled in Standard. At the office, you enrolled in Prime. Dental is separate, that's why I devoted separate paragraphs to it. It's not United Concordia anymore. Their contract expired in May. Dental insurance is now through MetLife. Every beneficiary got several letters explaining this and new insurance cards in the mail months ago. If you didn't, I highly suggest calling and making sure you're enrollment was transferred properly.
    imageDawnJM25:

    Extra tip:  Make sure DH fills out the paperwork to have one more dependent.  That is not automatic, and several of our military friends have missed out on extra pay from having another dependent in the family because they were never told to add the new baby. 

    "Several" of your military friends are wrong. You don't get any extra pay for having a baby. The number of dependents a service member has has no bearing on their base pay or incentive pay. BAH (housing allowance) is higher for SMs with dependents, but it does not change when you add additional dependents. Married SMs get dependent rate BAH because they have 1 dependent (the spouse). A SM with 10 kids gets the same dependent rate BAH. IT DOES NOT INCREASE WITH MORE DEPENDENTS.
    You do have to enroll and new children (bio or adopted) into DEERS. Children are automatically covered under Prime for the first 60 days after birth or adoption. During this time, you should enroll your child in DEERS and choose whether you want him/her covered under Prime or Standard, and adjust your coverage at the Tricare office accordingly.
     
    For the love of all things holy, please read the FAQs on this board and/or your Tricare handbook before answering questions.  

    Normally, I would never ever counter what Meltoine writes, because she is pretty much 100% correct. 

    But there is ONE exemption to her post and for young servicemembers it does get confused.

    If you are stationed overseas, you do get extra COLA per dependent.  That is to help offset the higher cost of living and the exchange rates between the US$ and certain currencies like the Euro. 

    This is NOT applicable in the CONUS, but is applicable in AK, HI, the various protectorates and any overseas duty stations.  But unlike BAH, if you or your dependent leaves the location for more than 30 days, you must contact finance or you will be held on fraud charges and at the very least your next check will be short by whatever you stole.

    And since our squadron alone just dealt with 3 of these charges in the last 4 months, the services are not taking these things lightly.

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  • Illumine - thanks for the info! I had no idea about COLA. We've never lived somewhere that warrants COLA some I'm unfamiliar with the who system. 
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  • imageanastasiacarmen:

    I always thought that you had to switch to Tricare Standard.  I have prime always have.  I had it while active duty and I now have it as a spouse.  I know ppl who where I am stationed now who had to change over to standard bc we have a small clinic at our post and they can't see everyone and the next closest place only takes standard. 

    Nope, you switch to Prime.  I would guess that you or YH did it and you don't realize that is the case.  I know it happens sometimes.  Just because you have a small clinic does not mean people had to change to Standard to be seen off base.  I am Prime and since the base hospital didn't have room for me, Tricare gave me a civilian Dr w/o changing to Standard.  I can choose to change to Standard if I choose too.  Maybe your friends chose to change over to Standard because they didn't like the Dr's in the network, but they didn't have to because the clinic was small.  I have been at a base with a small clinic, and I didn't have to change to Standard then either. 

  • imagemeltoine:
    Illumine - thanks for the info! I had no idea about COLA. We've never lived somewhere that warrants COLA some I'm unfamiliar with the who system. 

    This is a huge issue over here.  We are hundreds of thousands of dollars being stolen on our base alone.  An E5 with 3 dependents gets $ 17.278 a day for COLA.  That is $6,000 a year.  That is $18,000 in our squadron for just the 3 people caught in the last 3 months.  Can you imagine having to pay that back in one fell swoop?  No paycheck for a couple months? 

    Dependents go home for the summer (because there isnt a summer here - it was 57 and rainy all week) or when their DH's deploy.  And they keep the COLA because they "have expenses back in the US too you know".

    With the budget being slashed, with good SM being RIFed left and right, with our HC being threatened, COLA is going to be one thing that they look at.  And let me tell you, YOU CANNOT LIVE HERE WITHOUT IT. 

    Even though we get decent OHA, Utility Assistance, and Petrol subsidy, we still need that money to live on.  Our Commissaries are small and the cost to purchase on the economy is astronomical (IKEA isnt the number one furniture store because people LIKE the design, its because its affordable).

    I remember 7-8 years ago, there was this huge push to remove all of the American Bases in Germany and put them in Poland and the like, making them unaccompanied tours.  That was to cut the costs across the board, it is cheaper in Poland and they wouldnt have to pay for dependents.

    I would suspect that will come back again - this time because we have cut all of our bases and then will need to come back here again. 

    Either way, bad apples are taking the amazing opportunities away from everyone else AND stealing from the governemnt.

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  • https://www.tricare.mil/mybenefit/ProfileFilter.do?puri=%2Fhome%2Foverview%2FEligibility%2FDEERS%2FChildren

    Newborns, Adopted Children and Pre-Adoptive Children


     

    Your newborn or adopted child must be registered in the Defense Enrollment Eligibility Reporting System (DEERS) before you can enroll in any TRICARE health plan.

    To register your child in DEERS, you must submit the following to your ID card office:

    • An original or certified-copy of the 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 Identification Card/DEERS Enrollment (DD Form 1172-2) signed by the sponsor and verifying official from a uniformed services identification (ID) card-issuing facility. If the sponsor can't sign the DD Form 1172-2 in person at an ID card facility, then a notarized copy of the form is required. The spouse must submit presentation of a power of attorney if the sponsor didn't sign the DD Form 1172-2.

    You can apply for your child's Social Security number (SSN) on the Social Security Administration Web site, or by calling 1-800-772-1213 begin_of_the_skype_highlighting 1-800-772-1213 end_of_the_skype_highlighting. Once you receive your child's SSN, be sure to update their DEERS information.

    TRICARE Prime Coverage
    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; and
    • Pre-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.

    Note: To give parents overseas sufficient time to meet all TRICARE overseas eligibility requirements for newborns, the enrollment period for TRICARE Prime and TRICARE Prime Remote Overseas is 120 days.

    Your child loses TRICARE eligibility after 365 days unless they are enrolled in DEERS. >>Learn More

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  • This is the website for HUMANA the TRICARE Managed Care Support Contractor for the Southern Region

    Their contract is to follow the laws/policies/rules of the TRICARE Management Activity office.

    https://www.humana-military.com/south/bene/billing-enrollment/NewFamilyMembers.asp

    If you have a new little one in your life, or are expecting a child, you know that nothing means more to you than keeping your baby healthy and secure. Here?s one essential step: registering your newborn or newly adopted child in DEERS, the Defense Enrollment Eligibility Reporting System.

    DEERS is a database that tracks uniformed service members (sponsors), family members and others worldwide who are legally entitled to TRICARE benefits. It is important to register your baby in DEERS and enroll him or her in TRICARE Prime as soon as possible after birth or adoption, but no later than 60 days afterward if you want your son or daughter to avoid a lapse in TRICARE Prime coverage.

    How to Register Your Baby in DEERS

    To register your baby in DEERS you must submit the following to your ID card office: An original or certified-copy of the 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 Identification Card/DEERS Enrollment(DD Form 1172-2) signed by the sponsor and verifying official from a uniformed services identification (ID) card-issuing facility. If the sponsor can't sign the DD Form 1172-2 in person at an ID card facility, then a notarized copy of the form is required. The spouse must submit presentation of a power of attorney if the sponsor didn't sign the DD Form 1172-2.

    You can apply for your child's Social Security Number (SSN) on the Security Administration Website or call 1-800-772-1213 begin_of_the_skype_highlighting 1-800-772-1213 end_of_the_skype_highlighting. Once you receive your child's SSN, be sure to update their information in DEERS.

    How to Enroll Your Baby in TRICARE Prime

    Newborns or newly adopted children (except infants of dependent daughters) are automatically covered as a TRICARE Prime beneficiary for the first 60 days after birth, adopted children are covered 60 days beginning from the effective date of the actual adoption, and pre-adoptive children are covered for 60 days beginning on the date of placement of the court or approved adoption agency as long as one family member is enrolled in TRICARE Prime, TRICARE Prime Remote or TRICARE Prime Remote for Active Duty Family Members (TPRADFM). Claims for any civilian health care received for newborns during this time are paid under TRICARE Prime rules.

    After 60 days of not registering in DEERS, your baby becomes covered under TRICARE Standard, which means claims submitted for your baby?s care are subject to deductibles and cost shares?a more costly situation for you. Your baby will continue to be covered under TRICARE Standard until registered in DEERS and enrolled in TRICARE Prime, or until TRICARE Standard eligibility ends, which is 365 days after birth for any newborn not registered in DEERS.

    By promptly registering your baby in DEERS, you ensure maximum coverage for the lowest cost.

    To continue Prime coverage after 60 days you can enroll your baby through Beneficiary Web Enrollment (BWE) or by submitting a prime enrollment/PCM change form.

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  • This is the MCSC HealthNet's website regarding Enrollment Dates for Newborns.  Healthnet manages the North Region.

    https://www.hnfs.com/content/hnfs/home/tn/bene/enroll/enroll/effective_date.html

    Enrollment Effective Dates

    TRICARE Prime

    Your TRICARE Prime enrollment effective date depends on when your new TRICARE Prime enrollment application is received. Most new enrollment effective dates follow the 20th of the month rule.

    20th of the Month Rule:

    TRICARE Prime enrollment applications received on or before the 20th of the month are effective the first day of the next month.

    The 20th of the month rule applies to any new TRICARE Prime enrollment application with the following exceptions:

    • Newborns and newly adopted children: If a family member is enrolled in TRICARE Prime or the sponsor is an active duty service member, and a TRICARE Prime application is received by Health Net within 60 days from the date of birth/adoption, the child is considered TRICARE Prime from the date of birth/adoption. The TRICARE Prime effective date for children of retired service members will show in DEERS as the first day of the month following the date of birth/adoption. Children of active duty service members will show effective in TRICARE Prime on the date of birth/adoption.
    • Transitional Assistance Management Program (TAMP): A TRICARE Prime enrollment application must be received while you are eligible for TAMP for TRICARE Prime enrollment to be backdated to the date TAMP eligibility started. Family members must have been enrolled with TRICARE Prime through the last day of the sponsor's active duty orders to qualify for backdated coverage. A sponsor's enrollment is always backdated with TAMP, regardless of TRICARE Prime enrollment status while on active duty orders.
    • Active to retiree?retirement date is the 1st of any month: A TRICARE Prime enrollment application must be received on or before your sponsor's last day of active duty orders to qualify for continuous TRICARE Prime enrollment. Family members must have been enrolled with TRICARE Prime on the sponsor's last day of active duty orders to qualify for continuous coverage. The sponsor does not have to be enrolled while on active duty orders to qualify for continuous coverage.
    • Active to retiree?retirement date is not the 1st of the month: A TRICARE Prime enrollment application must be received within 30 days of your sponsor's retirement to qualify for continuous coverage. Family members must have been enrolled with TRICARE Prime on the sponsor's last day of active duty orders to qualify for continuous coverage. The sponsor does not have to be enrolled while on active duty orders to qualify for continuous coverage.
    • Portability (transfer): Currently enrolled TRICARE Prime or TRICARE Prime Remote members who submit a TRICARE Prime enrollment application will be effective the date the form is received.
    • TRICARE Reserve Select (TRS) to active duty: A TRICARE Prime enrollment application must be received within 30 days of your sponsor's active duty start date to qualify for backdated coverage. Sponsors and family members must have been enrolled with TRS the day before the sponsor's active duty start date to qualify for backdated coverage.
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  • Granted TriWest - West Region - just lost the contract, but I would suspect that (given they are trying to save their asses), they would be extra careful in publishing the TRICARE rules correctly right now.

    https://www.triwest.com/beneficiary/bolt/Home.mvc/Details/Newborn

    Newborn and Newly-Adopted Care Benefits

    All TRICARE-eligible newborns and newly-adopted are entitled to routine care. As long as one other family member is already enrolled in TRICARE Prime, claims for the newborn's care will be processed under Prime for the first 60 days following birth. If the newborn is not enrolled in Prime during this 60 calendar day period, at the end of the 60th calendar day, claims will process under Standard, applying the appropriate TRICARE cost-shares and deductibles.

    Note that the Point of Service option does not apply for 60 days after the birth or adoption of a child or until a Prime enrollment decision is made, whichever is earlier.

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