Starting in January, the automatic Tricare Prime enrollment period for newborns and newly adopted children will be reduced from 120 to 60 days.
If parents have not enrolled their child in Tricare Prime within 60 days, the child will be treated under Tricare Standard, said Frank McEvoy, Tricare Pacific marketing representative.
“We’re giving them a shorter time so we don’t elongate the process of getting them in the system properly,” he said.
According to a DOD Health Affairs memo outlining the policy change, swifter enrollment in Tricare Prime:
Ensures continuity of care.Reduces the time and simplifies the settling and processing of claims.Decreases the drain on Defense Department Military Health System funds.Automatic enrollment into Tricare Prime begins after a parent registers a child in the Defense Enrollment Eligibility Reporting System, or DEERS. DEERS is a computerized database of military sponsors, families and others worldwide who are entitled to Tricare benefits.
Tricare Standard carries different benefits than Tricare Prime, and, when receiving treatment from a civilian provider, added cost.
Under Tricare Standard, “you have to pay a deductible and then you have a 20 percent cost share after that” at a civilian hospital, McEvoy said.
In the Pacific theater, however, most military families are treated at military hospitals or clinics, where they aren’t billed for medical care, even if they opt for Tricare Standard, McEvoy noted. There is no network of Tricare-approved civilian providers, made up of local host-nation doctors, in the Pacific.
But signing up for Tricare Prime early ensures continuity of care for one’s child, McEvoy said. With the coverage, a child is assigned a primary care manager, or family doctor, which “gives you more of a guarantee that you’re going to see the same doctor and that you’re not going to be bouncing from doctor to doctor,” he said.
With Tricare Standard, “you see what doctor is available,” he said.
To participate in Tricare Prime, active duty family members must complete a Tricare Prime enrollment form. There is no enrollment fee for family members of military personnel.
DOD officials note that Tricare area offices are authorized after Jan. 1 to extend Tricare Prime coverage up to 120 days on a case-by-case or regional basis “due to the unique issues associated with deployments and with overseas locations.”
For more information, go to: www.tricare.osd.mil/.
