02 TRICARE MATERNITY CARE

Question 1

CONCERNING PREGNANCY, WHAT FACTORS DETERMINE THE CARE AND COSTS BEFORE, DURING, AND AFTER CHILDBIRTH?

Answer 1

1. BENEFICIARY STATUS
2. HOW CLOSE THE PREGNANT INDIVIDUAL LIVES TO A MILITARY HOSPITAL OR CLINIC THAT PROVIDES OBSTETRIC AND GYNECOLOGICAL SERVICES
3. THE SPONSOR’S CHOICE OF TRICARE PROGRAM AND PROVIDER

Question 2

HOW MANY MATERNITY SERVICES DOES TRICARE COVER IF MEDICALLY NECESSARY?

Answer 2

EIGHT

Question 3

WHAT IS THE FIRST MATERNITY SERVICES DOES TRICARE COVER IF MEDICALLY NECESSARY?

Answer 3

1. OBSTETRIC VISITS THROUGHOUT YOUR PREGNANCY

Question 4

WHAT IS THE SECOND MATERNITY SERVICES DOES TRICARE COVER IF MEDICALLY NECESSARY?

Answer 4

2. FETAL ULTRASOUNDS

Question 5

WHAT IS THE THIRD MATERNITY SERVICES DOES TRICARE COVER IF MEDICALLY NECESSARY?

Answer 5

3. HOSPITALIZATION FOR LABOR, DELIVERY, AND POSTPARTUM CARE

Question 6

WHAT IS THE FOURTH MATERNITY SERVICES DOES TRICARE COVER IF MEDICALLY NECESSARY?

Answer 6

4. ANESTHESIA FOR PAIN MANAGEMENT DURING LABOR AND DELIVERY

Question 7

WHAT IS THE FIFTH MATERNITY SERVICES DOES TRICARE COVER IF MEDICALLY NECESSARY?

Answer 7

5. CESAREAN SECTIONS

Question 8

WHAT IS THE SIXTH MATERNITY SERVICES DOES TRICARE COVER IF MEDICALLY NECESSARY?

Answer 8

6. MANAGEMENT OF HIGH-RISK OR COMPLICATED PREGNANCIES

Question 9

WHAT IS THE SEVENTH MATERNITY SERVICES DOES TRICARE COVER IF MEDICALLY NECESSARY?

Answer 9

7. DELIVERIES AT TREICARE-CERTIFIED/AUTHORIZED BIRTHING CENTERS (STATESIDE ONLY)

Question 10

WHAT IS THE EIGHTH MATERNITY SERVICES DOES TRICARE COVER IF MEDICALLY NECESSARY?

Answer 10

8. BREAST PUMPS, BREAST PUMP SUPPLIES, AND BREASTFEEDING COUNSELING

Question 11

UNDER ANY TRICARE PRIME OPTION, WHAT ARE THE COSTS FOR MATERNITY CARE?

Answer 11

ACTIVE DUTY SERVICE MEMBERS (ADSMS) AND ACTIVE DUTY FAMILY MEMBERS (ADFMS) HAVE NO COSTS FOR MATERNITY CARE UNDER ANY TRICARE PRIME OPTION.

Question 12

UNDER ANY OPTIONS OTHER THAN TRICARE PRIME, WHAT ARE THE COSTS FOR MATERNITY CARE?

Answer 12

OTHERS (INCLUDING THOSE ENROLLED IN TRICARE SELECT, TRICARE RESERVE SELECT (TRS), TRICARE RETIRED RESERVE (TRR), TRICARE YOUNG ADULT (TYA) SELECT, THE CONTINUED HEALTH CARE BENEFIT PROGRAM (CHCBP), AND RETIREES, THEIR FAMILY MEMBERS AND ALL OTHERS) HAVE COPAYMENTS AND/OR COST-SHARES.

Question 13

FOR NON-ADSM BENEFICIARIES WITH TRICARE PRIME, HOW CAN THEY SELF-REFER TO AN OBSTETRICIAN?

Answer 13

EXCEPT FOR ADSMS, BENEFICIARIES WITH A TRICARE PRIME OPTION MAY USE THE POINT-OF-SERVICE (POS) OPTION TO SELF-REFER TO AN OBSTETRICIAN, BUT WILL PAY HIGHER OUT-OF-POCKET COSTS.

Question 14

CONCERNING GETTING MATERNITY CARE, WHAT MAY BE REQUIRED TO OBTAIN MATERNITY SERVICES?

Answer 14

GUIDELINES FOR GETTING CARE BARY BASED ON YOUR TRICARE PROGRAM OPTION AND WHETHER YOU LIVE STATESIDE OR OVERSEAS. MATERNITY CARE SERVICES MAY REQUIRE REFERRALS AND/OR PRIOR AUTHORIZATIONS.

Question 15

WHAT ARE THE GUIDELINES FOR GETTING MATERNITY CARE FOR TRICARE PRIME?

Answer 15

IF YOUR PRIMARY CARE MANAGER (PCM) IS AT A MILITARY HOSPITAL OR CLINIC, YOU SHOULD GET MATERNITY CARE AT THE MILITARY HOSPITAL OR CLINIC. IF MATERNITY CARE IS UNAVAILABLE AT YOUR MILITARY HOSPITAL OR CLINIC, YOUR PCM WILL REFER YOU TO A CIVILIAN NETWORK PROVIDER. IF YOU HAVE A CIVILIAN PCM, YOUR PCM WILL DIRECT YOUR MATERNITY CARE OR GIVE YOU A REFERRAL TO AN OBSTETRICIAN.

Question 16

WHAT ARE THE GUIDELINES FOR GETTING MATERNITY CARE FOR TRICARE PRIME REMOTE (TPR)?

Answer 16

IF YOU HAVE TPR WITH AN ASSIGNED PCM, YOUR PCM WILL DIRECT YOUR CAREE. OTHERWISE YOU MAY VISIT A TRICARE-AUTHORIZED CIVILIAN PROVIDER WITH PRIOR AUTHORIZATION FORM YOUR REGIONAL CONTRACTOR.

Question 17

WHAT ARE THE GUIDELINES FOR GETTING MATERNITY CARE FOR TRICARE SELECT, TRICARE RESERVE SELECT (TRS), TRICARE RETIRED RESERVE (TRR), AND CONTINUED HEALTH CARE BENENFIT PROGRAM (CHCBP)?

Answer 17

YOU MAY GET CARE FROM ANY TRICARE-AUTHORIZED PROVIDER WITHOUT A REFERRAL. VISITS TO A NETWORK PROVIDER WILL COST YOU LESS OUT OF POCKET, AND THE PROVIDER WILL FILE CLAIMS FOR YOU. WITH A NON-NETWORK PROVIDER, YOU MAY PAY MORE OUT OF POCKET AND HAVE TO FILE YOUR OWN CLAIMS. NON-NETWORK PROVIDERS MAY CHARGE UP TO 15 PERCENT ABOVE TH TRICARE-ALLOWABLE CHARGE, AND YOU’RE RESPONSIBLE FOR THAT AMOUNT IN ADDITION TO ANY DEDUCTIBLE OR COST-SHARES.

Question 18

WHAT ARE THE GUIDELINES FOR GETTING MATERNITY CARE FOR TRICARE OVERSEAS PROGRAM (TOP) PRIME AND TOP PRIME REMOTE?

Answer 18

YOU SHOULD GET MATERNITY CARE FROME A MILITARY HOSPITAL OR CLINIC IF YOUR PCM IS LOCATED THERE IF YOU AREN’T LOCATED NEAR A MILITARY HOSPITAL OR CLINIC, OR CARE THERE IS UNAVAILABLE, YOUR PCM WILL GIVE YOU A REFERRAL TO A TRICARE-AUTHORIZED CIVILIAN PROVIDER IN YOUR OVERSEAS AREA. IF YOU HAVE TOP PRIME REMOTE, YOUR TOP REGIONAL CALL CENTER WILL HELP YOU COORDINATE CARE.

Question 19

WHAT ARE THE GUIDELINES FOR GETTING MATERNITY CARE FOR TOP SELECT AND OVERSEAS TRS, TRR, AND CHCBP?

Answer 19

YOU MAY SEEK CARE FROM ALMOST ANY TRICARE-AUTHORIZED CIVILIAN PROVIDER WIHTOUT A REFERRAL TO PAY UP FRONT FOR CARE AND SUBMIT A CLAIM WITH PROOF OF PAYMENT TO GET MONEY BACK. OUTSIDE THE U.S. AND U.S. TERRITORIES (AMERICAN SAMOA, GUAM, THE NORTHERN MARIANA ISLANDS, PUERTO RICO, AND THE U.S. VIRGIN ISLANDS), THER EMAY BE NO LIMIT TO THE AMOUNT THAT NONPARTICIPATING NON-NETWORK PROVIDERS MAY BILL, AND YOU’RE RESPONSIBLE FOR PAYING ANY AMOUNT THAT EXCEEDS THE TRICARE-ALLOWABLE CHARGE IN ADDITION TO YOUR DEDUCTIBLE, COST-SHARES, AND COPAYMENTS.

Question 20

WHAT ARE THE GUIDELINES FOR GETTING MATERNITY CARE SPECIFICALLY UNDER TOP SELECT - ESPECIALLY IN THE PHILLIPPINES?

Answer 20

NOTE: UNDER TOP SELECT, YOU MAY RECEIVE CARE FROM ANY HOST NATION PROVIDER WITHOUT A REFERRAL. IF YOU LIVE OR TRAVEL IN TH PHILIPPINES, YOU’RE REQUIRED TO SEE A CERTIFIED PROVIDER FOR CARE. ADDITIONALLY, TOP SELECT BENEFICIARIES WHO RESIDE IN THE PHILIPPINES ADN WHO SEEK CARE WITHIN POCKET COSTS ARE LOWER WHEN USING A PREFERRED PROVIDER.

Question 21

WHAT ARE THE GUIDELINES FOR GETTING MATERNITY CARE FOR TRICARE YOUNG ADULT (TYA)?

Answer 21

YOUG ADULTS WHO HAVE PURCHASED COVERAGE UNDER TYA FOLLOW THE RULES (INCLUDING COSTS AND PROVIDER CHOICES) OF THE PLAN THEY HAVE - EITHER TYA PRIME OR TYA SELECT.

Question 22

WHAT ARE THE GUIDELINES FOR GETTING MATERNITY CARE FOR TRICARE DENTAL PROGRAM?

Answer 22

DURING PREGNANCY, A THIRD CLEANING IS COVERED IN A 12-MONTH PERIOD.

Question 23

ALL NEWBORN AND ADOPTED CHILDREN MUST BE REGISTERED IN WHAT AND WITHIN WHAT TIMEFRAME?

Answer 23

DEFENSE ENROLLMENT ELIGIBILITY REPORTING SYSTEM (DEERS) WITHIN 90 DAYS (120 DAYS IF OVERSEAS).

Question 24

WHAT MUST THE SPONSOR DO TO REGISTER A NEWBORN/ADOPTED CHILD IN DEERS?

Answer 24

TO DO THIS, THE SPONSOR MUST GO TO A UNIFORMED SERVICES ID CARD OFFICE AND PRESENT THE CHILD’S BIRTH CERTIFICATE, CERTIFICATE OF LIVE BIRTH FROM THE HOSPITAL, RECORD OF ADOPTION, OR LETTER OF PLACEMENT OF YOUR CHILD INTO YOUR HOME BY A RECOGNIZED PLACEMENT OR ADOPTION AGENCY OR THE COURT.

Question 25

WHAT HAPPENS IF A CHILD IS REGISTERED IN DEERS AFTER THE ALLOTTED TIME PERIOD?

Answer 25

THEY WILL ONLY BE ABLE TO RECEIVE CARE IF SPACE IF AVAILABLE AT A MILITARY HOSPITAL OR CLINIC.

Question 26

WHAT IS THE ONLY TIME A SPONSOR CAN ENROLL THE CHILD IN AN ELIGIBLE TRICARE PLAN?

Answer 26

THE SPONSOR CAN ONLY ENROLL THE CHILD IN AN ELIGIBLE TRICARE PLAN AFTER ANOTHER QUALIFYING LIFE EVENT (QLE) OR DURING THE TRICARE OPEN SEASON.

Question 27

NEWBORN AND ADOPTED CHILDREN OF TRS OR TRR MEMBERS CAN’T BECOME QUALIFIED FOR COVERAGE AND ENROLL IN TRS OR TRR UTNIL REGISTERED IN WHAT?

Answer 27

NEWBORN AND ADOPTED CHILDREN OF TRS OR TRR MEMBERS CAN’T BECOME QUALIFIED FOR COVERAGE AND ENROLL IN TRS OR TRR UNTIL REGISTERED IN DEERS.

Question 28

ONCE REGISTERED IN DEERS, CHILDREN OF ADSMS WILL BE AUTOMATICALLY ENROLLED IN WHAT PLAN BASED AN WHAT?

Answer 28

ONCE REGISTERED IN DEERS, CHILDREN OF ADSMS WILL BE AUTOMATICALLY ENROLLED IN A TRICARE PLAN BASED ON WHERE THEY LIVE.

Question 29

WHAT IS DIFFERENT ABOUT TRICARE ENROLLMENT FOR CHILDREN OF RETIREES?

Answer 29

FOR CHILDREN OF RETIREES, THERE IS NO AUTOMATIC ENROLLMENT PROCESS. CHILDREN OF RETIREES MUST FIRST BE REGISTERED IN DEERS WITHIN 90 DAYS (120 DAYS IF OVERSEAS), AND THEN THE FAMILY MUST CONTACT THEIR TRICARE CONTRACTOR TO ENROLL THEM IN A DESIRED TRICARE PLAN.

Question 30

WHAT ARE THE TWO CONDITIONS UNDER WHICH STATESIDE CHILDREN OF ADSMS MUST BE IN ORDER TO BE AUTOMATICALLY ENROLLED IN TRICARE PRIME?

Answer 30

1. THEY ARE REGISTERED IN DEERS 2. THEY LIVE IN A STATESIDE PRIME SERVICE AREA (PSA). IF THEY DON’T LIVE IN A PSA, THE CHILD WILL BE AUTOMATICALLY ENROLLED IN TRICARE SELECT.

Question 31

WITHIN WHAT TIMEFRAME MUST YOU CHOOSE TO CHANGE YOUR CHILD’S COVERAGE TO ANOTHER TRICARE PLAN OR US FAMILY HEALTH PLAN (USFHP)?

Answer 31

YOU MAY CHOOSE TO CHANGE YOUR CHILD’S COVERAGE TO ANOTHER TRICARE PLAN OR US FAMILY HEALTH PLAN (USFHP), IF ELIGIBLE, WITHIN 90 DAYS FROM THE DATE ENTERED IN DEERS.

Question 32

WHEN CAN A CHILD’S COVERAGE BE CHANGED IF IT IS ALREADY AFTER 90 DAYS FROM THE DATE ENTERED IN DEERS?

Answer 32

AFTER 90 DAYS, YOU MUST WAIT UNTIL ANOTHER QLE OR TRICARE OPEN SEASON TO ENROLL YOUR CHILD IN A DIFFERENT TRICARE PLAN.

Question 33

IN WHAT TRICARE PLAN IS A NEWBORN BORN OVERSEAS AUTOMATICALLY ENROLLED WHEN REGISTERED IN DEERS?

Answer 33

TOP SELECT

Question 34

WITHIN WHAT TIMEFRAME DOES ONE HAVE TO CHANGE A NEWBORN’S ENROLLMENT AND TO WHAT PLAN?

Answer 34

YOU’LL HAVE 90 DAYS FROM THE DATE OF DEERS REGISTRATION TO CHANGE OR TRANSFER YOUR NEWBORNS ENROLLMENT TO TOP PRIME OR TOP PRIME REMOTE (IF ELIGIBLE AND COMMAND-SPONSORED).

Question 35

WHAT HAPPENS (OVERSEAS) IF A CHILD IS NOT ENROLLED WITHIN 90 DAYS OF REGISTERING IN DEERS?

Answer 35

IF YOU DON’T ENROLL WITHIN THE 90 DAY PERIOD, YOUR CHILD WILL REMAIN IN TOP SELECT.

Question 36

IF THE SPONSOR ENROLLS THE NEWBOR IN TOP PRIME OR TOP PRIME REMOTE, WHAT HAPPENS TO THE COVERAGE FOR THE TIME PERIOD PRIOR TO THE CHANGE IN COVERAGE FROM TOP SELECT TO TOP PRIME OR TOP PRIME REMOTE?

Answer 36

IF THE SPONSOR ENROLLS THE NEWBORN IN TOP PRIME OR TOP PRIME REMOTE, COVERAGE IS BACKDATED TO THE DATE OF BIRTH AND THE FAMILY MAY ASK THE TOP CONTRACTOR TO REPROCESS ANY CLAIMS THAT EITHER WERE DENIED OR SHOULD BE PROCESSED UNDER TOP PRIME OR TOP PRIME REMOTE.

Question 37

HOW ARE NEWBORNS AND NEWLY ADOPTED CHILDREN COVERED UNDER TRICARE YOUNG ADULT?

Answer 37

UNDER TYA, NEWBORN AND NEWLY ADOPTED CHILDREN AREN’T COVERED BY TRICARE UNLESS THE CHILD’S OTHER PARENT IS A SPONSOR OR THE CHILD IS ADOPTED BY A SPONSOR. THEY’LL ALSO NOT BE ABLE TO RECEIVE CARE FROM A MILITARY HOSPITAL OR CLINIC

Question 38

HOW ARE NEWBORNS AND NEWLY ADOPTED CHILDREN COVERED UNDER CONTINUED HEALTH CARE BENEFIT PROGRAM (CHCBP)?

Answer 38

IF YOUR CHILD IS BORN OR ADOPTED UDNER CHCBP COVERAGE, YOU MAY NOT NEED TO REGISTER HIM OR HER IN DEERS. (CONTACT THE CHCBP CONTRACTOR, HUMANA MILITARY, TO ENROLL YOUR CHILD IN THE CHCBP)

Question 39

HOW MANY STEPS ARE LISTED IN THE TRICARE MATERNITY CARE BROCHURE FOR ENROLLING IN TRICARE - WHAT ARE THEY?

Answer 39

THREE STEPS. 1. LOG IN TO MILCONNECT WEBSITE > BENEFITS TAB > BENEFICIARY WEB ENROLLMENT (BWE) 2. CALL YOUR REGIONAL CONTRACTOR OR USFHP CUSTOMER SERVICE REPRESENTATIVE. OVERSEAS, CALL YOUR GLOBAL TRICARE SERVICE CENTER. 3. MAIL IN ENROLLMENT FORM - FORMS FOUND ON TRICARE.MIL/FORMS

Question 40

IF YOU TAKE A TRIP/TRAVEL FOR MORE THAN 30 DAYS CAN YOU KEEP YOUR TRICARE PRIME ENROLLMENT?

Answer 40

IF YOU HAVE TRICARE PRIME AND PLAN TO TRAVEL FOR MORE THAN 30 DAYS, YOU MAY KEEP YOUR CURRENT TRICARE PRIME ENROLLMENT OR TRANSFER YOUR ENROLLMENT IF TRICARE PRIME IS AVAILABLE IN YOUR NEW LOCATION.

Question 41

IF YOU TAKE A TRIP/TRAVEL FOR MORE THAN 30 DAYS AND KEEP YOUR TRICARE PRIME ENROLLMENT IN YOUR ORIGINAL LOCATION, WHAT MUST BE DONE?

Answer 41

IF YOU KEEP YOUR TRICARE PRIME ENROLLMENT IN YOUR ORIGINAL ENROLLED LOCATION, YOU NEED TO COORDINATE WITH YOUR PCM TO GET REFERRALS FOR NON-EMERGENCY HEALTH CARE SERVICES YOU GET IN THE LOCATION YOU’RE VISITING. TO TRANSFER YOUR ENROLLMENT, CONTACT YOUR REGIONAL CONTRACTOR..

Question 42

IF YOU ARE OVERSEAS AND TAKE A TRIP/TRAVEL FOR MORE THAN 30 DAYS WHAT CAN BE DONE ABOUT YOUR TRICARE OVERSEAS PLAN ENROLLMENT?

Answer 42

OVERSEAS, DIFFERENT RULES APPLY COMPARED TO NON-OVERSEAS. CONTACT YOUR TOP REGIONAL CALL CENTER FOR GUIDANCE..

Question 43

IF YOU ARE OVERSEAS AND TAKE A TRIP/TRAVEL FOR MORE THAN 30 DAYS WHAT CAN BE DONE ABOUT OBTAINING CARE USING TRICARE SELECT OR TOP SELECT IN A NEW LOCATION?

Answer 43

IF YOU’RE USING TRICARE SELECT OR TOP SELECT, YOU MAY GET CARE FROM ANY TRICARE-AUTHORIZED PROVIDER (UNLESS LOCAL COUNTRY RESTRICTION APPLY) IN YOUR NEW LOCATION WITHOUT A REFERRAL.

Question 44

CAN YOU LOSE YOUR TRICARE ELIGIBLITY?

Answer 44

YES. YOU MAY LOSE TRICARE ELIGIBILITY, INCLUDING MATERNITY COVERAGE, FOR VARIOIUS REASONS RELATED TO LIFE EVENTS AND SPONSOR STATUS CHAGES. DEPENDING ON THR REASON FOR LOSING ELIGIBILITY, YOU MAY QUALIFY FOR CONTINUED COVERAGE UNDER THE TRANSITIONAL ASSISTANCE MANAGEMENT PROGRAM, TYA, OR CHCBP. TYA AND CHCBP REQUIRE PREMIUM PAYMENTS. IF YOU’RE AN ADSM WHO IS PREGNANT AT THE TIME OF RELEASE FROM ACTIVE DUTY, YOU MAY ALSO WORK WITH YOUR SERVICE (UNIT PERSONNEL AND MILITARY HOSPITAL OR CLINIC ADMINISTRATIVE CHANNELS) TO DETERMINE IF YOU’RE ELIGIBLE FOR ONGOING CARE AT A MILITARY HOSPITAL OR CLINIC.