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Tricare Help: How can we get coverage for grandson?

Jul. 19, 2012 - 03:45PM   |   Last Updated: Jul. 19, 2012 - 03:45PM  |  
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Q. I am a retired airman with Tricare Prime for myself and my family. Our 6-year-old grandson, our daughter's son, lives with us, and we have been awarded joint conservatorship of him, to include primary residency and health care responsibilities. How can we enroll him in our Tricare family plan? Despite the fact that our grandson has lived with us for most of his life and we are responsible for all aspects of his care and well-being, he was denied DEERS enrollment under my sponsorship.

A. Tricare eligibility is established by federal law; Tricare has no authority to make eligibility determinations. By law, only the services may determine whether a particular individual meets the legal criteria for Tricare eligibility, to register an eligible person in the Defense Enrollment Eligibility Reporting System, and to issue an appropriate uniformed service identification card.

The law is not very flexible when it comes to covering grandchildren. There are only two ways for the child to be covered by Tricare:

• If the father is an active-duty or retired service member, the child could be covered under the father's Tricare sponsorship.

• If another Tricare sponsor — you, in this case — legally adopted the child, he would be covered as a son; he would no longer be a grandchild for Tricare eligibility purposes.

If no one at the DEERS office explained these details to you, you can confirm the above by calling the DEERS support office, toll-free, at 800-538-9552.

Q. I am scheduled for an intraocular implant lens replacement due to cataracts in my eye. I do not see this procedure listed as covered in the Tricare for Life Web pages for eye surgery. Does TFL cover the balance due after my Medicare Part B pays its approved share?

A. When medically necessary and appropriate for the particular Tricare beneficiary, the costs of surgery to remove and replace the eye's natural lens is covered by Tricare, as is one pair of eyeglasses following the surgery, if medically necessary.

Note that Tricare may cover the procedure only when performed by a Tricare-authorized provider. An authorized provider is one that is registered with Tricare and is approved to be paid by Tricare for covered medical services provided to Tricare beneficiaries. Tricare may not pay for any health-related services received from an unauthorized provider.

Contact your Tricare regional contractor (see www.tricare.mil/ contacts) for more information.

Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or tricarehelp@militarytimes.com?subject=RE:%20Tricare">tricarehelp@militarytimes.com. In email, include the word "Tricare" in the subject line and do not attach files. Get Tricare advice anytime at http://www.militarytimes.com/tricarehelp">www.militarytimes.com/tricarehelp.

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