TRICARE is a health benefit program for all seven uniformed
services: the Army, Navy, Marine Corps, Air Force, Coast Guard,
Public Health Service, and the National Oceanic and Atmospheric
Administration. To use TRICARE, you must be listed in DEERS
as being eligible for military health care benefits. If you
don’t find answers to your eligibility questions in this section,
check with your military service personnel office for specific
information.
TRICARE-eligible persons include the following:
Active duty service members
Spouses and unmarried children of active duty service
members
Uniformed service retirees, their spouses, and unmarried
children
Un-remarried former spouse and unmarried children of active
duty or retired service members who have died Note: Family
members of active duty service members who died while on
active duty, and who were on active duty for at least 31
days before death, will continue to be treated as active
duty family members for TRICARE cost-sharing purposes for
3 years after their active duty sponsor dies.
Spouses and unmarried children of reservists and National
Guard who are ordered to active duty for more than 30 consecutive
days (they are covered only during the reservist’s active
duty tour) or of reservists and National Guard who die on
active duty.
Spouses and unmarried children of reservists and National
Guard who die as a result of a line of duty condition may
be eligible for health care.
Persons who have received the Congressional Medal of Honor,
and their family members, who are not otherwise TRICARE
eligible. These persons will be able to obtain health care
benefits under TRICARE in the same manner as if they were
entitled to retired pay.
Unmarried children up to age 21 (including stepchildren
who are adopted by the sponsor) are still covered by TRICARE
even if the spouse gets divorced or remarried. But in the
case of a stepchild who was not adopted by the sponsor and
the marriage ends in divorce, the stepchild loses eligibility
on the date the divorce decree is final. It should be emphasized
that stepchildren don’t have to be adopted by the sponsor
to be covered by TRICARE while the sponsor and the mother
or father of the stepchildren remains married. A child aged
21 or over may be covered if he or she is severely disabled
and the condition existed prior to the child’s 21st birthday—or,
if the condition occurred between the ages of 21 and 23
while the child was enrolled in a full-time course of study
in an approved institution of higher learning and is, or
was at the time of the sponsor’s death, dependent on the
sponsor for more than one-half of his or her support. A
child may also be covered up to the 23rd birthday if he
or she is in school full-time.
Children placed in the custody of a service member or
former member, by a court of law; or by a recognized adoption
agency in anticipation of legal adoption by the member.
TRICARE eligibility is effective July 1, 1994, if a court
of law places the child. A child placed by a recognized
adoption agency is eligible effective October 5, 1994.
Children of current or former service members or their
spouses born out of wedlock may be eligible for TRICARE
benefits under certain conditions. Check with your Beneficiary
Counseling and Assistance Coordinator (BCAC)/Health Benefits
Adviser (HBA), or TRICARE Service Center (TSC).
Certain family members of active duty service members
who were court-martialed and separated for spouse or child
abuse. The victims of the abuse within the family are eligible
for health benefits for the period that the abused family
member is receiving “transitional compensation” under Section
1059 of Title 10, U.S. Code. Cost sharing will be the same
as for other active duty families.
Certain abused spouses, former spouses, and dependent
children of service members who were eligible for retirement,
but had that eligibility taken away as a result of abuse
of the spouse or child. This benefit is effective for medically
necessary services and supplies provided under TRICARE Standard
(CHAMPUS) on or after October 23, 1992.
Spouses and children of North Atlantic Treaty Organization
(NATO) and "Partners for Peace" (PFP) nation representatives
who are officially accompanying the NATO or PFP nation representatives
while stationed in, or passing through, the United States
on official business. These family members are eligible
for outpatient benefits only (including ambulatory surgery).
They are not listed in the DEERS files, and should check
with a BCAC/HBA/TSC for assistance before getting care or
filing claims. (NATO and PFP family members cannot enroll
in TRICARE Prime.)
Former spouses of active or retired military who were
married to a service member or former member who had performed
at least 20 years of creditable service for retirement purposes
at the time the divorce or annulment occurred. The former
spouse must also meet the following requirements:
Must not have remarried. Must not be covered by an
employer-sponsored health plan.
Must not be the former spouse of a NATO (or "Partners
for Peace" nation) member.
Must meet the requirements of one (not all) of the
following three situations:
Situation 1: Must have been married to the same member
or former member for at least 20 years, and at least
20 of those married years must have been creditable
in determining the member’s eligibility for retirement
pay. If the date of the final decree of divorce or
annulment was on or after February 1, 1983, the former
spouse is eligible for TRICARE coverage of health
care that is received after that date. If the date
of the final decree is before February 1, 1983, the
former spouse is eligible for TRICARE coverage of
health care received on or after January 1, 1985.
Situation 2: Must have been married to the same military
member or former member for at least 20 years, and
at least 15—but less than 20— of those married years
must have been creditable in determining the member’s
eligibility for retirement pay. If the date of the
final decree of divorce or annulment is before April
1, 1985, the former spouse is eligible only for care
received on or after January 1, 1985, or the date
of the decree, whichever is later.
Situation 3: Must have been married to the same military
member or former member for at least 20 years, and
at least 15—but less than 20— of those married years
must have been creditable in determining the member’s
eligibility for retirement pay. If the date of the
final decree of divorce or annulment is on or after
September 29, 1988, the former spouse is eligible
for care received for only one year from the date
of the decree. Upon completion of the period of eligibility
for TRICARE, explained in Situation 3 above, a former
spouse is eligible for the Continued Health Care Benefit
Program (CHCBP). Check with your BCAC/HBA/TSC for
details.
