Understanding TRICARE Maternity Health Benefits
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As active duty military personnel come back from their tours, there has been a bit of a baby boom at the bases. Whether a spouse chooses to stay or move closer to family during pregnancy, service members need to know what their maternity benefits are in order to help their family. Consider the following information regarding TRICARE maternity benefits eligibility and terms for GIs and their families.
Register With DEERS For TRICARE EligibilityIn order to be eligible for TRICARE benefits in the first place, you need to register with the Defense Enrollment Eligibility Reporting System (DEERS).
A newborn or adopted child also needs to enroll in DEERS. Military sponsors or the other parent of the child needs to bring in a copy of their birth certificate or adoption papers to the closest military base or personnel office.
TRICARE Prime And Prime Remote For Active Duty Family Members (TPRADFM)After registering your child with DEERS, a parent or guardian need to complete and submit the TRICARE Prime Enrollment Application & PMC Change Form. You can find it online at triwest.com.
Your child is covered for the first two months, but after Day 61, he or she will be paid as TRICARE Standard. You must enroll your child in TRICARE Prime within 60 days of birth or adoption to avoid a gap in the coverage.
If a service member is deployed and their spouse chooses to stay with her family in a different location to have the baby, she will need to use Point of Service (POS), which increases in fees.
If Prime is offered where she is moving to, she needs to change her enrollment from TPRADRM to TRICARE Prime. If she moves somewhere that does not offer TRICARE Prime, she can save money by switching from TPRADFM to TRICARE Standard for childbirth coverage.
Ultrasounds, Referrals And Other Issues With TRICARE Maternity CareAs of 2006, TRICARE covers ultrasounds when it is medically necessary. However, obstetric ultrasounds that verify the gender of the baby are not covered by TRICARE.
Many military treatment facilities are not offering obstetric care anymore. If you need prenatal care but live in an area where it is unavailable, you will be referred to TRICARE civilian providers. If you have another form of health insurance, you do not need a referral since you can use this provider instead.
Active duty family members under TRICARE Prime have no co-pays or deductibles. TRICARE Standard members, however, will have their maternity care paid for under a maternity fee and will need to pay a $15 co-pay per visit or $25 charge per admission. Deductibles are waived for Reserve Component members and their families.
If you have a daughter who becomes pregnant and she is covered under TRICARE, the baby will not be covered until after birth. The only way they will be covered is if you become the child’s legal guardian.
Remember if you still have any questions, you can visit the TRICARE website at triwest.com.
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