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TRICARE Eligibility

TRICARE delivers health care, but it does not determine who is and who is not eligible to receive care – the Uniformed Services make that decision. Active duty Soldiers, their family members, retirees and their family members, surviving family members of deceased active
or retired Soldiers, and certain former spouses (who meet length-of-marriage rules and other requirements) are eligible for health care.

The Services supply eligibility information to the Defense Enrollment Eligibility Reporting System (DEERS), whose computerized database maintains eligibility information. Sponsors are responsible for ensuring that their family members are properly enrolled in DEERS and that their information is kept up-to-date in DEERS through the unit personnel office. For information about DEERS registration, contact the DEERS Support Office (DSO) Telephone Center at 1-800-538-9552, or for the deaf (TTY/TDD) at 1-866-363-2883. Hours of operation are Monday through Friday from 6:00 a.m. to 3:30 p.m. Pacific time, except federal holidays.

TRICARE is a health benefit program for all seven uniformed services: the Army, Navy, Marine Corps, Air Force, Coast Guard, Public Health Service, and the National Oceanic and Atmospheric Administration. To use TRICARE, you must be listed in DEERS as being eligible for military health care benefits. If you don’t find answers to your eligibility questions in this section, check with your military service personnel office for specific information.

TRICARE-eligible persons include the following:

  • Active duty service members
  • Spouses and unmarried children of active duty service
    members
  • Uniformed service retirees, their spouses, and unmarried
    children
  • Un-remarried former spouse and unmarried children of active
    duty or retired service members who have died Note: Family
    members of active duty service members who died while on
    active duty, and who were on active duty for at least 31
    days before death, will continue to be treated as active
    duty family members for TRICARE cost-sharing purposes for
    3 years after their active duty sponsor dies.
  • Spouses and unmarried children of reservists and National
    Guard who are ordered to active duty for more than 30 consecutive
    days (they are covered only during the reservist’s active
    duty tour) or of reservists and National Guard who die on
    active duty.
  • Spouses and unmarried children of reservists and National
    Guard who die as a result of a line of duty condition may
    be eligible for health care.
  • Persons who have received the Congressional Medal of Honor,
    and their family members, who are not otherwise TRICARE
    eligible. These persons will be able to obtain health care
    benefits under TRICARE in the same manner as if they were
    entitled to retired pay.
  • Unmarried children up to age 21 (including stepchildren
    who are adopted by the sponsor) are still covered by TRICARE
    even if the spouse gets divorced or remarried. But in the
    case of a stepchild who was not adopted by the sponsor and
    the marriage ends in divorce, the stepchild loses eligibility
    on the date the divorce decree is final. It should be emphasized
    that stepchildren don’t have to be adopted by the sponsor
    to be covered by TRICARE while the sponsor and the mother
    or father of the stepchildren remains married. A child aged
    21 or over may be covered if he or she is severely disabled
    and the condition existed prior to the child’s 21st birthday”or,
    if the condition occurred between the ages of 21 and 23
    while the child was enrolled in a full-time course of study
    in an approved institution of higher learning and is, or
    was at the time of the sponsor’s death, dependent on the
    sponsor for more than one-half of his or her support. A
    child may also be covered up to the 23rd birthday if he
    or she is in school full-time.
  • Children placed in the custody of a service member or
    former member, by a court of law; or by a recognized adoption
    agency in anticipation of legal adoption by the member.
    TRICARE eligibility is effective July 1, 1994, if a court
    of law places the child. A child placed by a recognized
    adoption agency is eligible effective October 5, 1994.

  • Children of current or former service members or their
    spouses born out of wedlock may be eligible for TRICARE
    benefits under certain conditions. Check with your Beneficiary
    Counseling and Assistance Coordinator (BCAC)/Health Benefits
    Adviser (HBA), or TRICARE Service Center (TSC).
  • Certain family members of active duty service members
    who were court-martialed and separated for spouse or child
    abuse. The victims of the abuse within the family are eligible
    for health benefits for the period that the abused family
    member is receiving “transitional compensation” under Section
    1059 of Title 10, U.S. Code. Cost sharing will be the same
    as for other active duty families.
  • Certain abused spouses, former spouses, and dependent
    children of service members who were eligible for retirement,
    but had that eligibility taken away as a result of abuse
    of the spouse or child. This benefit is effective for medically
    necessary services and supplies provided under TRICARE Standard
    (CHAMPUS) on or after October 23, 1992.
    Spouses and children of North Atlantic Treaty Organization
    (NATO) and "Partners for Peace" (PFP) nation representatives
    who are officially accompanying the NATO or PFP nation representatives
    while stationed in, or passing through, the United States
    on official business. These family members are eligible
    for outpatient benefits only (including ambulatory surgery).
    They are not listed in the DEERS files, and should check
    with a BCAC/HBA/TSC for assistance before getting care or
    filing claims. (NATO and PFP family members cannot enroll
    in TRICARE Prime.)

  • Former spouses of active or retired military who were
    married to a service member or former member who had performed
    at least 20 years of creditable service for retirement purposes
    at the time the divorce or annulment occurred. The former
    spouse must also meet the following requirements:

    • Must not have remarried. Must not be covered by an
      employer-sponsored health plan.
    • Must not be the former spouse of a NATO (or "Partners
      for Peace" nation) member.
    • Must meet the requirements of one (not all) of the
      following three situations:

      Situation 1: Must have been married to the same member
      or former member for at least 20 years, and at least
      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 was on or after February 1, 1983, the former
      spouse is eligible for TRICARE coverage of health
      care that is received after that date. 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.

      Situation 2: 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 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.

      Situation 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
      for care received for only one year from the date
      of the decree. Upon completion of the period of eligibility
      for TRICARE, explained in Situation 3 above, a former
      spouse is eligible for the Continued Health Care Benefit
      Program (CHCBP). Check with your BCAC/HBA/TSC for
      details.

     

TRICARE Links
TRICARE Overview
TRICARE Prime
TRICARE Standard
TRICARE Extra
 
TRICARE & American Association of Pediatrics
TRICARE & DEERS (Defense Enrollment Eligibility Reporting System)
TRICARE & WIC (Women, Infants, and Children)
TRICARE Claims How to file a TRICARE Claim
TRICARE Continued Health Care Benefits
TRICARE Dental
TRICARE Eligibility
TRICARE Family-Centered Care includes Obstetric Care
TRICARE for Life
TRICARE for Life and Medicare
TRICARE Generic Pharmacy Brochure
TRICARE Information – Puerto Rico
TRICARE Overseas
TRICARE Pharmacy
TRICARE Prime Enrollment Info
TRICARE Prime Remote
TRICARE Prime Travel and Non-Medical Attendant (NMA)
TRICARE Providers
TRICARE Reserve Select
TRICARE Standard vs Prime

Comments

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