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Tricare Help: Coverage tricky for woman pregnant by married retiree

Jun. 6, 2013 - 04:04PM   |  
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Q. I am having a baby with a medically retired Army veteran. He is married, but not to me. His wife left him while he was still on active duty, and he hasn’t seen or spoken to her in four years. With his income, he cannot afford a divorce, and she will not file for one because she still receives benefits for being married to him. I am unsure of my options; how can I help our son get the benefits he deserves?

A. Unless you are married to the Army retiree, you cannot obtain any military or Tricare health coverage for yourself. However, once your son is born, he will be fully eligible for Tricare under the father’s status as a military retiree, as long as the baby is properly registered in the Defense Enrollment Eligibility Reporting System, the Defense Department’s portal for determining eligibility for various military benefits, including health care.

The baby’s Tricare options will be Tricare Prime, the military’s version of an HMO, which is available in some areas, or Tricare Standard, the military’s version of a fee-for-service plan.

Prime requires payment of an annual enrollment fee, and specialty care and referrals are coordinated through a primary care manager. Standard allows a much broader choice of health care providers and has no primary care managers or annual enrollment fee, but it requires payment of deductibles and cost shares; out-of-pocket costs under Standard generally are higher than under Prime.

Again, the most important initial consideration is to get the baby registered in DEERS. Without that, the baby is not eligible for Tricare coverage. Dependent children normally do not get a military ID card until age 10, but in certain situations, they may be issued one earlier than that. Yours may be one such situation.

Contact the ID Card/DEERS office of any sizable military installation, or call the main DEERS support office toll free at 800-538-9552 for further guidance.

Q. My husband recently started on Tricare for Life. If we assume legal custody/guardianship of our 12-year-old granddaughter, will she become our military dependent and eligible for Tricare benefits? I realize there will be a premium similar to our previous Tricare Prime.

A. There is some debate about whether legal guardianship is sufficient to establish Tricare eligibility for a grandchild. Tricare itself has said grandchildren must be legally adopted to become eligible for Tricare under a grandparent’s military sponsorship.

But some legal advocates argue that the Tricare operating regulations are unclear on this point and that legal guardianship is, in fact, sufficient to establish Tricare eligibility for a grandchild.

Tricare itself does not make such eligibility determinations; only the military services may do that, through the Defense Enrollment Eligibility Reporting System database. You can call the main DEERS support office toll free at 800-538-9552.

Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or tricarehelp@militarytimes.com. In email, include the word “Tricare” in the subject line and do not attach files. Get Tricare advice any time at www.militarytimes.com/tricarehelp.

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