Tricare Help

I’m Dad’s dependent; will Tricare cover my baby?

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I am 16 years old and I am covered by my dad’s Tricare. I’m going to have a baby – will my dad’s Tricare cover it? Or will I have to get insurance for her from somewhere else?

Unfortunately, while Tricare will cover your maternity care and any services related to the actual birth of your baby, Tricare will not cover any care or services for the baby after he or she is born. Tricare eligibility does not normally extend to grandchildren of service members. Tricare officials have said in the past that the only way that can happen is if the military sponsor/grandparent legally adopts the grandchild. However, some military family advocates argue that the Tricare operating regulations are vague on this point, and that a grandchild can be covered by Tricare if the military sponsor/grandparent assumes legal guardianship of the grandchild.

However, Tricare doesn’t make these kinds of eligibility determinations; only the military services may do that, through what is called the Defense Enrollment Eligibility Reporting System (DEERS), a Defense Department database that acts as an eligibility portal for Tricare. Your father should contact the ID Card/DEERS office of his nearest military installation or call the main DEERS support office toll-free at 1-800-538-9552 for more information and further guidance.

Will granddaughter be covered if we take custody?

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My husband recently started 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.

There is some debate about whether legal guardianship is sufficient to establish Tricare eligibility for a grandchild. Tricare itself has told me in the past that grandchildren must be legally adopted in order 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 contact the ID Card/DEERS office at your nearest military installation, or call the main DEERS support office toll-free at 1-800-538-9552.

Can disabled vets’ grandchildren get Tricare coverage?

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I am a 100 percent permanently disabled vet. Are my grandchildren eligible for Tricare?

Veterans are not eligible for military health care through the Defense Department unless you served at least 20 years in uniform or you received medical disability retirement short of 20 years of service. If you meet either of those criteria, you and your spouse, if you have one, are eligible for health care under the Defense Department’s Tricare program, as are any children up to age 21, or up to age 23 if they are full-time college students. After those ages, children are eligible until age 26 for a program called Tricare Young Adult, which charges monthly premiums.

Only the military services can make Tricare eligibility determinations; Tricare itself has no authority to do that. Grandchildren generally are not eligible for Tricare coverage unless they are legally adopted by the grandparent/military sponsor, although in some circumstances it’s possible grandchildren may be deemed eligible if the grandparent becomes their legal guardian.

Of course, if your disability is service-related, you are eligible for health care through the Veterans Affairs Department. However, family members are not eligible for VA health care.

You can get more information on your potential eligibility for military health care coverage under Tricare by contacting the Defense Enrollment Eligibility Reporting System support office at (800) 538-9552.

DEERS is the Defense Department’s eligibility portal for Tricare.

If I become grandson’s legal guardian, can he be covered by Tricare?

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I am a retired Air Force officer with Tricare Prime coverage for myself and family. We’re currently in litigation to obtain permanent guardianship of our 5-year-old grandson. Should we be successful, will I be able to add him to my Tricare Prime coverage?

Eligibility rules for Tricare are not very flexible when it comes to grandchildren; the only way for them to become eligible for Tricare under a grandparent’s sponsorship is if the grandparent legally adopts the grandchild. Legal guardianship is not sufficient.

How can we get grandson covered by Tricare?

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I am a retired airman with Tricare Prime for myself and my family. Our 6-year-old grandson, our daughter’s son, also lives with us, and we 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.

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 DEERS, 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:

  1. If the father is an active-duty or retired service member, the child could be covered under the father’s Tricare sponsorship.
  2. 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 DEERS explained these details to you, you can confirm the above by calling the DEERS support office, toll-free, at 1-800-538-9552.