Tricare coverage for newborns/dependents

Editor’s note: Story has been localized from Defense Health Agency Press Release May 25, 2021 “GETTING TRICARE COVERAGE FOR YOUR NEWBORN CHILD”

Welcoming a new baby is an exciting and nerve-wracking time; doctor visits and health care coverage invite numerous life-altering questions.

That’s where TRICARE can help.

When a baby is born, this qualifies as a Qualifying Life Event (QLE). Qualified members are able to enroll newborns or make changes to TRICARE Prime or TRICARE Select coverage.

Getting TRICARE for your newborn or child is done in two steps:

1. Register the child in the Defense Enrollment Eligibility System (DEERS).

2. Members will then choose a TRICARE health plan, enroll the child or make eligible enrollment changes.

“In the days following the birth of your child, there may be services that are necessary for your newborn,” said U.S. Air Force Maj. Syrah Nicaisse, 633rd Surgical Operations Squadron OBGYN Services flight commander. “Following the appropriate steps in enrolling your newborn in healthcare coverage will ensure that there is not a lapse in their care and that you will be able to receive the support that is necessary in your immediate days as a new family.”

Below are more details about this two-step process and when to take action.

1. Registering Child in DEERS

When the baby is born, sponsors must register them in DEERS. This applies if you adopt or have a child placed in your home by court appointment. DEERS registration ensures that your child can use TRICARE. Stateside sponsors have 90 days from the QLE to register their child; overseas sponsors have 120 days.

As the sponsor, you will visit a Uniformed Services ID card office to complete the registration. Bring your child’s birth certificate, proof of adoption, or letter of placement. A Social Security number is not necessary to start the registration process, but updating your child’s DEERS record once he or she receives a Social Security number is mandatory.

Keep registration timelines in mind; TRICARE may deny claims if children aren’t registered in DEERS during the allotted time period.

“During this time you should be able to focus on learning your newborn’s personality, bonding, breastfeeding, and getting the proper rest that your body needs,” Nicaisse said. “Not having appropriate healthcare coverage should you need it can cause undue stress as well as unnecessary financial hardships.”

2. Choosing or Confirming Enrollment in a TRICARE Plan

After the child is registered in DEERS, they will need to be enrolled in a TRICARE plan. The sponsor’s duty status determines whether or not this enrollment is automatic.

Active duty family living stateside:

• The child is automatically enrolled in TRICARE Prime if living in a Prime Service Area (PSA).
• If living outside of a PSA, your child is automatically enrolled in TRICARE Select.
• Sponsors have 90 days to change the child’s enrollment to a different health plan.
• If the child is registered in DEERS late, the child’s coverage is backdated to the date of birth. The TRICARE contractor can help with reprocessing claims.

Active duty family living overseas:

• Child is automatically enrolled in TRICARE Overseas Program (TOP) Select. Be sure your address in DEERS shows as overseas for automatic enrollment to work.
• Sponsors have 90 days to change the child’s enrollment to TOP Prime or TOP Prime Remote, as long as the child is command-sponsored.
• If a child is registered in DEERS late, the child’s coverage is backdated to the date of birth. Contact the TOP contractor about reprocessing any claims.

If you’re a retiree:

• There’s no automatic enrollment.
• Sponsors have 90 days (120 days if overseas) to register the child in DEERS.

Keep in mind that TRICARE won’t backdate coverage for retirees if the child is not enrolled during the allotted time period. Sponsors will be responsible for all costs from day 91 (or 121 if overseas) until their child is enrolled in a health plan.

“Securing TRICARE coverage for your newborn is an important step once you’re back home from the hospital,” said Shane Pham, Defense Health Agency Policy and Programs Section of the TRICARE Health Plan program analyst. “This ensures your child is covered for important doctor visits and medical services.”

For questions concerning TOP or TRICARE contractor support in your region, please visit tricare.mil or contact your primary care physician.