TRICARE Prime Handbook

Previous Page          Table of Contents          Next Page


Life Events


Having a Baby or Adopting a Child

You should register your newborn or adopted child in DEERS as soon as possible. To register your child in DEERS, you need only a certificate of live birth or adoption. The document does not need to be a certified copy of the official birth certificate. It can be a certificate of live birth authenticated by either the attending physician or other responsible party from the hospital. Note: Registration in DEERS is a separate step from enrolling in Prime.

Children are covered as TRICARE Prime beneficiaries for 60 days after birth as long as one other family member is enrolled in TRICARE Prime. If you wish to keep your child enrolled in TRICARE Prime, you must submit an enrollment application to Humana Military within 60 days of birth or adoption for continuous Prime coverage.

On day 61, if you have not enrolled the child in TRICARE Prime, he or she will be covered automatically under TRICARE Standard and TRICARE Extra until 365 days after the child’s birth or adoption. On day 366, if the child is not registered in DEERS, DEERS will show “loss of eligibility,” and he or she will no longer be able to receive TRICARE benefits until they are registered in DEERS.
        
Eligibility Requirements for Former Spouses                                                                Figure 5.2
 1

• 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.

• If the date of the final decree of divorce or annulment was on or after February 1, 1983, the former spouse is eligible for TRICARE coverage of health care that is received after the date of the divorce or annulment.

• If the date of the final decree is before February 1, 1983, the former spouse is eligible for TRICARE coverage of health care received on or after January 1, 1985.

• Eligibility continues as long as the preceding requirements continue to be met.

• Must have been married to the same military member or former member 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 pay
 2

• If the date of the final decree of divorce or annulment is before April 1, 1985, the former spouse is eligible only for care received on or after January 1, 1985, or the date of the decree, whichever is later.

• Eligibility continues as long as the preceding requirements continue to be met. However, if the date of the final divorce decree or annulment is on or after April 1, 1985, but before September 29, 1988, the former spouse is eligible for care received from the date of the decree until December 31, 1988, or two years from the date of the decree, whichever is later.
3

• Must have been married to the same military member or former member 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 pay. • If the date of the final decree of divorce or annulment is on or after September 29, 1988, the former spouse is eligible only for care received for one year from the date of the decree.


Going to College

Eligibility
Your children remain eligible for TRICARE up to age 21 (or age 23 if enrolled in college full-time and the sponsor provides at least 50 percent of the financial support) as long as their information is kept up to date in DEERS. To extend benefits for your college student beyond his or her 21st birthday, please contact DEERS to verify what documentation is needed to extend coverage. Representatives there will be able to advise you about the documentation you need to update DEERS and extend coverage. Note: In most cases, children going overseas to attend college on their own are eligible only for TRICARE Standard in the overseas area.

If your child loses DEERS eligibility, his or her TRICARE Prime coverage will end automatically. If you believe your child is still eligible for TRICARE, you will need to contact DEERS to update his or her record. Once DEERS is updated, you must contact Humana Military for information if you want to re-enroll your child in TRICARE Prime. Otherwise, your child will be covered under TRICARE Standard and TRICARE Extra.

TRICARE benefits end when your college student reaches age 23 or when full-time student status ends, whichever comes first. For example, if your child turns 23 on January 3, but doesn’t graduate until May, coverage ends at midnight on January 2.

Note: Children with a disability may remain eligible for TRICARE beyond the normal age limits. Please check with DEERS for eligibility criteria.

Health Care Options

If TRICARE Prime is available where your child is attending school and the school is in your TRICARE region, your child only needs to select a new primary care manager (PCM). If the school is in a different TRICARE region, your child may remain enrolled in TRICARE Prime using the split-enrollment feature if TRICARE Prime is available in that area.

Split Enrollment
Split enrollment allows families living in separate TRICARE regions to enroll in TRICARE Prime together. To use split enrollment, you must notify each family member’s contractor of the split enrollment status and establish one family payer for enrollment fees (where applicable). Humana Military will coordinate enrollment fees and send the statements to the designated payer. An enrollment fee left unpaid causes the entire family to be disenrolled. Key points to remember with split enrollment:
  • Families with college students, children living with former spouses, or families otherwise separated can enroll together in separate regions.
  • Active duty families are not required to pay enrollment fees, but they can still enroll in separate regions.
  • Retiree families have only one enrollment fee and one enrollment anniversary date.
  • There is no limit on the number of family members enrolling.
  • In most cases, only those family members who accompany their active duty sponsor on his or her orders overseas will be enrolled in TRICARE Overseas Program Prime options.
If your child does not enroll in TRICARE Prime, he or she will be covered automatically by TRICARE Standard and TRICARE Extra as long as his or her information is kept up to date in DEERS. Browse Humana Military's Web site site or call the toll-free number 1-800-444-5445 if you have questions about using TRICARE Standard and TRICARE Extra.

Back to Top
Last Reviewed: July 11, 2008