TRICARE for Teens
Coverage For Your College-Bound Child
by Brian P. Smith, TriWest Healthcare Alliance
The Centers for Disease Control and Prevention estimates that nearly 30 percent of college-age young adults have no insurance coverage. Fortunately for TRICARE-eligible families, full-time students may remain covered throughout their college career (up to their 23rd birthday).
THE BASICS
Your child will usually lose eligibility for TRICARE benefits at age 21. Children attending college can extend their TRICARE benefits until age 23 if:
- Over 50 percent of the student’s financial support is provided by the sponsor.
- The student remains enrolled full-time at an accredited institution.
- Documentation for the above is provided to a uniformed services ID-card-issuing facility prior to the child’s 21st birthday.
If your college student is eligible for TRICARE health benefits you must choose his coverage program. If he’s staying at home, or attending a school close to home, you will probably continue using your existing TRICARE program. If he’s moving he can still access TRICARE benefits through Prime, Standard or Extra. (See “Navigating Your TRICARE Benefits” on page TK for an in-depth explanation of each.)
To help prevent claims delays or denials, keep your child updated in the Defense Enrollment Eligibility Reporting System (DEERS) and make sure he always has a valid DEERs card that shows TRICARE eligibility. If your child is 18 or older he has automatically assumed the right to his personal health information through the Health Insurance Portability and Accountability Act (HIPPA) privacy rule. If he needs his information updated, he’ll have to do it himself or fill out the appropriate paperwork with your TRICARE regional contractor to grant you access.
ROAD TRIP!
When your child travels or returns home, TRICARE coverage follows. Students with Prime coverage will have to coordinate non-emergency care with their primary care manager. For long stays (over 30 days) outside of their home region, enrollment can easily be transferred over to the new regional contractor. Students with TRICARE Standard and Extra coverage will still be responsible for applicable deductibles, cost-shares and, in most cases, completing/filing the claim paperwork while out of their home region.
OTHER HEALTH INSURANCES
Some colleges and universities offer health plans for students. TRICARE benefits pay second to any other health insurance, including student-specific health plans or employer-sponsored health insurance.
DON’T PAY DOUBLE!
Split enrollment allows a student with Prime coverage to live in a different TRICARE region than their sponsor. If his sponsor has to pay an annual Prime fee, it’s due to the TRICARE regional contractor where the sponsor resides. Only one fee is paid per family, even if the TRICARE-eligible dependent lives in another region. The student coordinates care with his or her local primary care manager.