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Adding a new family member stateside? Take action to get TRICARE coverage

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TRICARE Health Program

Whether giving birth or adopting, this change in your family composition is a TRICARE Qualifying Life Event (QLE). The QLE allows you to enroll any new eligible family members. Or to make changes to your TRICARE Prime or TRICARE Select health plan. You must take action to get TRICARE coverage for your newborn or adopted child. Register your newborn or adopted child in the Defense Enrollment Eligibility Reporting System (DEERS), as well as choose a TRICARE health plan and enroll your child in one if necessary.

You Must Register Your Child in DEERS

If you’re an active duty service member or a retiree living stateside, you must register your child in DEERS within 90 days of birthadoption, or court-appointment. To do this, the sponsor must go to a uniformed services ID card office. There they’ll show the child’s birth certificate, proof of adoption, or letter of placement of the child into their home by the court.

Don’t wait for the government to issue your child’s Social Security number to register your child in DEERS. However, update your child’s DEERS record as soon as he or she gets a Social Security number.

If you don’t register your child in DEERS, your child won’t show as TRICARE-eligible. TRICARE will deny claims for your child starting on the 91st day after the date of birth.

Choose a TRICARE Health Plan and Enroll if Necessary

After you register your child in DEERS, choose a TRICARE health plan and enroll your child if necessary. If you’re an active duty family living in a stateside Prime Service Area (PSA), your child is automatically enrolled into TRICARE Prime. If you don’t live in a PSA, your child is automatically enrolled into TRICARE Select. You have 90 days from the automatic enrollment date to change your child’s enrollment to a different TRICARE health plan. For example, TRICARE Prime Remote or US Family Health Plan, if available. After 90 days, you can only enroll your child following another QLE or during TRICARE Open Season.

For children of stateside retirees, there’s no automatic enrollment. You must enroll your child in a health plan after registering him or her in DEERS within 90 days. If you don’t enroll your child in a health plan, your child can only get health care and pharmacy services at a military hospital or clinic if space is available. Your child won’t have access to TRICARE covered civilian health care or retail or home delivery pharmacy services.

Avoid Late DEERS Registration

If you’re an active duty service member and register your child in DEERS after the 90 days, your child is automatically enrolled in TRICARE PrimeA managed care option available in Prime Service Areas in the United States; you have an assigned primary care manager who provides most of your care.TRICARE Prime or TRICARE SelectStarting on January 1, 2018, TRICARE Select replaces TRICARE Standard and Extra. TRICARE Select is a self-managed, preferred provider network plan. TRICARE Select is a fee-for-service option in the United States that allows you to get care from any TRICARE-authorized provider.  Enrollment is required to participate. TRICARE Select. Coverage will backdate to the date of birth, date of adoption, or date of court order. You still have 90 days from the auto-enrollment date to change your child’s health plan. TRICARE will backdate the new health plan to the date of birth, for example. Ask your TRICARE regional contractor to re-process any health care claims that TRICARE denied or that they should process under the new plan.

For retirees, if you register your child in DEERS late, TRICARE won’t backdate coverage. Your child will only be able to receive care at a military hospital or clinic if space is available. You have to pay all civilian health care costs from day 91 until you enroll your child in a TRICARE health plan. You can only enroll your child in a health plan during the annual open season (only applies to TRICARE Prime and TRICARE Select plans) or following another QLE.

Learn more about getting TRICARE coverage for your child. And visit Qualifying Life Events to learn about other QLEs you might experience in the future.

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