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Tricare Help: Switch from Tricare Prime relatively easy

Nov. 18, 2012 - 02:02PM   |   Last Updated: Nov. 18, 2012 - 02:02PM  |  
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Q. I'm a 51-year-old retiree enrolled in Tricare Prime. With four children in their 20s, my wife and I would like to switch to my company's policy so that all our children may be covered until age 26. That would be less expensive than trying to cover them individually under the new Tricare Young Adult program. In about six years, my wife and I would switch back to Tricare Prime. How can we make this transition as smooth as possible?

A. As a retiree, the eligibility of you and your family for Tricare remains in place regardless of whether you use Tricare as your primary insurance.

If you have other health insurance, the law requires that Tricare be last payer, save for a few narrow exceptions that don't apply to you. So in the scenario you outline here, your company's insurance would be the primary payer and Tricare would act as secondary payer, if necessary.

To avoid the annual Tricare Prime enrollment fee during that period, you simply must disenroll from Prime for however long you are covered by your company's insurance. Disenrollment is done through the Tricare managed-care contractor for your region.

When you disenroll from Prime, your Tricare coverage shifts automatically to Tricare Standard; you don't need to do anything further, as Standard does not require enrollment. When you want to go back to Prime, simply contact the Tricare contractor and indicate your desire to re-enroll.

Beneficiaries may voluntarily disenroll from Prime once per fiscal year (Oct. 1-Sept. 30) without being locked out. If you disenroll for a second time in a fiscal year, you can't re-enroll in Prime for 12 months. (There's an exception to this lockout rule for family members of active-duty troops in paygrades E-1 to E-4.)

Q. My son is getting out of the Marine Corps next month. His wife is pregnant. Tricare says he'll have to get other insurance to cover the baby's birth. He's willing to pay premiums for insurance until after the baby is born. What can he do?

A. Your son was correctly informed — if he's leaving service voluntarily and does not plan to transition into a reserve component, he'll lose Tricare coverage when he separates.

One option to consider is the Continued Health Care Benefit Program. The CHCBP is not technically a Tricare program, but it offers coverage similar to Tricare Standard. It's designed to be transitional health care insurance for up to 18 months to cover service members and their families in the period between when a member leaves service and obtains civilian employment. The program also will cover most pre-existing conditions.

CHCBP requires payment of quarterly premiums, however, and they're not cheap. Family coverage is currently $2,555 per quarter, or about $852 per month. You can get more details at www.tricare.mil/chcbp.

Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or tricarehelp@militarytimes.com. In email, include the word "Tricare" in the subject line and do not attach files. Get Tricare advice anytime at www.militarytimes.com/tricarehelp.

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