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TRICARE Qualifying Life Events and Your Health Insurance

TRICARE

When you enroll in TRICARE, your status as a single or married service member determines the type of coverage you’ll enroll in.

So does your status as an active duty service member. When these things change, they may be considered Qualifying Life Events, which provides an opportunity to modify your TRICARE coverage within a 90-day window of the event. You may (depending on circumstances) be able to enroll in a new TRICARE plan or change the nature of your health care coverage in other ways.

Qualifying Life Events (QLE)

If you get married, have a child, experience a death in the family, or separate from military service, you have experienced a TRICARE QLE.

Basically, any change in your status that may require additional health care coverage may be considered a QLE from what’s already been mentioned above to other situations like dependent children becoming adults or moving away to college, accepting military retirement pay, or other factors.

These are not the only ones that may open a 90-day window for you to change your coverage, but no matter how you experience a QLE it is important to review your current policy and talk to a TRICARE rep to learn how you may be able to change your health care to suit your current needs.

In order to modify an existing plan or enroll in a new one, you must update DEERS with information related to your Qualifying Life Event, make enrollment changes within 90 days, and pay any required fees or premiums needed for the new coverage.

A List of TRICARE Qualifying Life Events

This list may not be comprehensive. QLE requirements are subject to change through legislation, TRICARE program changes, or other variables. The following list is current at press time:

  • Retiring or separating from active duty
  • Activating or deactivating for federal service
  • Getting married or divorced
  • Getting an annulment
  • Birth or adoption of a child
  • Having a child placed in the home by a court
  • Children becoming adults
  • Death in the family
  • Children moving away to college
  • Relocation to a new zip code
  • Gaining or losing a Primary Care Manager
  • Dependents gaining or losing command sponsorship at a military assignment
  • Turning 60
  • Becoming eligible for Medicare
  • Gaining or losing other health insurance

What to Know About Qualifying Life Events

Some QLEs aren’t good. Losing a Primary Care Manager (PCM), for example, requires you to find a new one and begin a new relationship with your replacement PCM. Other situations are just as unpleasant, but more punitive. A good example would be a dependent losing command sponsorship at an overseas assignment due to misconduct–not uncommon depending on the location and other variables.

What do you need to know about TRICARE in such cases? If you don’t report these changes in status for TRICARE beneficiaries, when it comes time to get care for these beneficiaries you may be denied payment under TRICARE and be liable for the full cost of the care. Failing to report QLEs in cases where coverage eligibility is in question may result in a loss of coverage.

This is also true in cases where the enrollee is about to age into Medicare or start drawing military retirement pay. If you do not choose to modify your TRICARE coverage in these cases you may lose it when you age out or officially become a military retiree.

What to Do After a Qualifying Life Event

After any QLE you will need to update your DEERS records to reflect your new status after the event. Once your DEERS records are updated you can make any TRICARE changes  you’re authorized to make online, by mail, or by phone.

You May Not Have to Change Your Coverage

If you experience a TRICARE Qualifying Life Event, you are not required to modify your coverage in certain cases. In others you are definitely required to act.

In cases where you remain eligible for the current health plan following the QLE, you do not need to do anything. If you are not in a health plan and fail to enroll, your only healthcare options may be military hospitals and/or clinics. You are not guaranteed treatment under such conditions, it may be provided on a space available basis.

In cases where you are due to retire from active duty you must make a TRICARE “enrollment decision” within 90 days of your retirement date. Failure to do so may result in your losing health care coverage.

Making Enrollment Changes When You Haven’t Experienced a QLE

You do not have to wait until you experience a Qualifying Life Event to change your TRICARE coverage, but if there is no QLE you will have to wait until TRICARE open season begins. Open Season happens annually starting on the Monday of the second full week in November to the Monday of the second full week in December.

In 2022 open season was scheduled for November 14 through December 13, 2022. If you decide to make changes in your enrollment during open season, those changes may typically happen at the beginning of the new year.

Who Does Open Season Apply to?

The TRICARE official site says open season enrollment is for anyone in or eligible to enroll in TRICARE Prime options including TRICARE Select and the U.S. Family Health Plan. Those eligible for open season have three courses of action they can use:

  • Remain in your current TRICARE plan. You will not be required to re-enroll and you can stay in the plan as long as you are eligible to do so.
  • Enroll in a TRICARE plan if you are eligible but not currently enrolled in TRICARE plans such as Prime or TRICARE select.
  • Change TRICARE plans. Are you already enrolled in a TRICARE Prime option or TRICARE Select? The TRICARE official site says you are permitted to change plans and/or switch between individual and family TRICARE enrollment.

Enrolling In TRICARE Health Plans

Coverage by TRICARE is automatic when troops are sent to basic training. That does NOT mean you are automatically ENROLLED in a healthcare program. When it is time to enroll or to change your enrollment, you can do so online using the milConnect portal, or you can submit enrollment forms by mail or fax. There are different forms for TRICARE Prime, TRICARE Select, and the U.S. Family Health Plan. You can also enroll by phone. You will need to call a regional contractor or coordinator:

Starting or changing your healthcare coverage may require you to provide proof of identity, updated DEERS records, and other information. The safety of your private data including account numbers, Social Security Numbers, and other information is key–you will need to remember some best practices where safeguarding your personal data is concerned.

When you begin or change TRICARE coverage, keep in mind that you should never give out private information including bank account numbers or routing numbers to third parties who have called you unsolicited. It’s one thing for you to call the number or numbers listed above to make arrangements for coverage.

It’s another thing entirely to get a phone call you did not solicit from a number you don’t recognize and have that person claim to be your health insurance representative. Never give private data or payment data to someone who has called you unsolicited.

TRICARE warns about such scams. Always refuse to give information to people who have called you. It’s different when YOU have called THEM. If you suspect you have been contacted by a scammer claiming to represent TRICARE, contact a representative immediately. If you gave any personal data to the caller, be sure to let the representative know and be sure to ask what steps you need to take next to protect your accounts and your identity.