I’ve carried a military ID card since 1978. I’m financially independent. You would expect that I’d understand my benefits by now, but a few months ago I was nearly dis-enrolled from Tricare for not paying my premiums. To make matters even worse, I managed to thoroughly screw up our college daughter’s Tricare benefits. I’ll explain how this happened, and you can learn from my mistakes.
No Longer A Tricare Delinquent
A year ago UnitedHealthcare (yeah, that’s how they spell it, no spaces) took over Tricare’s western region (which includes Hawaii). The transition was ugly and there was confusion among their staff about the administrative procedures.
As part of the turnover, in March 2013 (over a year ago) UHC mailed out new Tricare Prime enrollment forms. I’ve had Tricare Prime for over a decade and saw no reason to re-enroll just because the contractors were switching. I was happy to supply my bank information for the automatic deduction, but they also wanted two months of premiums in advance. I could imagine a double-payment scenario where they’d cash my (paper) check for two months’ premiums (April and May) and then automatically deduct the April & May premiums from my checking account. To avoid this double-payment problem, I marked the advance-payment box “N/A” and mailed in the form.
That was my first mistake. It turns out that setting up an automatic deduction can take nearly two months. (Hence the two-month advance payment.) UHC would have completed the paperwork in April, the bank computer would have initiated the first automatic deduction in late May, and the premium would have been properly drawn from my account on 2 June. If I had just trusted the UHC system, I would have been fine. Those of you who’ve dealt with Tricare Prime contractors can understand why I was reluctant to trust the new Tricare contractor.
Instead, my “N/A” initiative caused the UHC computer to kick back my application. The customer service staff couldn’t figure out the problem but a supervisor eventually explained how an automatic deduction enrollment works. I finally paid the delinquent premiums with my credit card (plus another two months in advance) and marked my calendar for the July automatic deduction.
The deduction didn’t happen, and in mid-July I received yet another past-due notice. When I called another UHC supervisor, it turned out that they’d incorrectly entered my checking account number and the system wouldn’t process it. Even worse, they wanted me to pay a “refused transaction” fee. Supervisor #2 was able to review my original application and verify that I’d supplied the correct numbers, so we processed another credit-card charge and she agreed to re-enter the automatic deduction application. She even offered to personally check in October that the deduction went through.
The deduction didn’t happen. To make matters worse, Supervisor #2 had updated my file with a completely different version of the events than we’d discussed on the phone. She had also been promoted to another department of UHC. Due to my apparent repeated delinquency, supervisor #3 was ready to dis-enroll me and make me apply all over again. I suggested that they review their phone recording and she said that she’d look into it.
This time UHC wanted their premium in advance, and they’d only accept a quarterly payment. We processed a credit-card charge for October-December, and then I filed yet another application (with two months’ advance payment for January-February) to begin the automatic deductions in March… nearly a year since we’d started this turnover.
I filed a grievance with Tricare about Supervisor #2 and asked them to review the recordings. A month later, Tricare responded with a boilerplate letter assuring me that they’d resolved the matter… whatever that means.
The March premium deduction went through. The April deduction went through too. I appear to be finished with this problem… although the stench memory will linger for quite a while!
Lesson learned: when signing up for Tricare Prime (or switching to a new contractor), be ready to pay two months’ premiums in advance until their system is set up for an automatic deduction.
Tricare When Your Adult Children Reach Age 21
Our next Tricare problem totally blindsided me.
Let me backtrack a couple of decades. When my spouse and I married, we were both on active duty with our own ID cards and our own Tricare benefits. When our daughter was born, we made her my family member in the Defense Eligibility Enrollment Reporting System because I’d receive the bigger “with dependents” housing allowance. Eight years later when my spouse left active duty later to become a drilling Reservist, she also picked up a family ID card (for Tricare benefits). Whenever my spouse had to show an ID then she’d use either her Reserve military ID or her family member ID. There have been times over the last decade when her family member ID has expired, but she could always use her Reserve military ID for base access or (when she was on Reserve orders) for medical care. To us, an expiring family member ID card was no big deal.
Then our daughter joined the Navy on her ROTC scholarship and got her own Reserve ID card. When your teen is five time zones away at college and their military family ID expires in the middle of the semester, it’s a colossal pain to have a new ID issued by their local military facility. We saw that problem coming and we renewed her family member ID before she left the island. Problem avoided, right?
When she was home last summer after her junior year of college, her family member ID only had six months left before expiration. We didn’t think that was a problem since she had her Reserve military ID. During the fall semester of senior year she even mentioned to me that her family member military ID card was expiring, but we decided that didn’t matter because she had her Reserve military ID card. She turned age 21 in the middle of the semester and her family ID card expired. We didn’t renew it after the semester because we spent her entire Christmas break in Bangkok. (One last blowout family vacation before she starts her Navy sea duty.) None of us saw any reason for her to have a family member ID card any longer.
Some of you more experienced parents are already groaning…
In February (months after her 21st birthday) she called me in a panic. She needed to have a minor medical test for her commissioning physical, but she couldn’t get a doctor’s appointment because she no longer had Tricare benefits. She wasn’t even in DEERS. To make things even worse, her Mainland college is in another Tricare region. Since she’s an adult, the other Tricare contractors didn’t want to discuss her medical benefits with us parents.
As we all now know, it turns out that the 21st birthday is a really big freakin’ deal for a military family member. The ID card expires at age 21 to force the sponsor to validate their family member’s DEERS status for medical benefits.
The UnitedHealthcare representative said that they send the sponsor (and the family member) a letter warning that the young adult is about to turn age 21 and needs to update DEERS. However, our daughter attends college in a separate Tricare region, so UHC didn’t did have her in their files and didn’t send a letter to us parents. It’s possible that our daughter’s Tricare contractor mailed a letter to her college address, but if she got it then she wouldn’t have appreciated its significance. (Hey, we’d discussed it, and she has her military ID. Why would she need to update DEERS?) It turns out that the DEERS update can only be done for full-time college students when they’re within 90 days of their 21st birthday. The good news is that since they’re adults they can renew their own ID card and don’t have to have their sponsor present.
DEERS, of course, won’t accept a college’s student ID as verification of full-time enrollment. The college has to supply an enrollment verification letter (for a $5 processing fee) which took a day to obtain. While our daughter was working on that I filled out the DEERS application, printed out the PDF, scanned it, and e-mailed it to her. She took the documents to her local military ID card issuing facility, and they gave her a new family member ID.
Getting back into DEERS was only the start of the hassle. Now that she was back in DEERS, UHC was ready to return her to Tricare– sort of. Her Tricare Standard access was available immediately, but Tricare Prime would take until the beginning of the following month. When I inquired whether this happened with all 21-year-olds, they admitted that it was only because she was a “new” member of DEERS.
When I called the DEERS help line, it turned out to be just the database support contractor. They said that any changes to the system had to be made by the facility that issued the ID card. When I tracked down that facility, an extremely helpful Army Sergeant Peltier came on the line. He had actually issued the new ID card to my daughter, and he remembered her. (He’s planning a Hawaii vacation so they’d talked about Waikiki.) When I explained the Tricare situation (which seems to happen fairly often) he backdated the issue date of the ID card to her 21st birthday. (And then I gratefully answered every other question he had about his vacation plans.) The DEERS database updated overnight.
The next day UHC discovered that they could immediately reinstate my daughter in Tricare Prime, but first they wanted a UHC Reenrollment/Reinstatement Request Form. I also had the usual HIPAA debate with the customer service representative, who didn’t want to talk to me about my adult family member’s healthcare arrangements without her permission. I faxed the reinstatement form and e-mailed my daughter an authorized representative form for her to sign and send to UHC.
When I called UHC the next day, they hadn’t received the forms. I repeated the fax process and put another copy in the postal mail. Both of those applications disappeared too.
I finally asked whether I should call the Tricare contractor in my daughter’s Tricare region. UHC eventually understood that she was in a different region and immediately declared that I’d have to call the other region. The other Tricare region contractor (Humana) said that they needed UHC to put my family member back in their system before Humana could transfer her enrollment to the other region.
This administrative hilarity continued for two more days of phone calls and “supervisory research” between the two contractors. When they were finished, I finally had all my family members back in Tricare Prime.
Lesson learned: up to 90 days before their 21st birthday, your full-time student needs to procure a college verification letter and take it to a military ID facility for a new ID card. If they’re not a full-time college student then they’ll have to sign up for Tricare Young Adult or find their own insurance through a PPACA healthcare exchange.
Our daughter graduates and commissions in a few weeks. She can’t wait to start her life in the real Navy!
(Click here to return to the top of the post.)
Military Financial Independence on Amazon:
TRICARE Prime premiums and United Healthcare (May 2013)
I’m still a Tricare delinquent (July 2013)
“Our daughter graduates and commissions in a few weeks. She can’t wait to start her life in the real Navy!”
… where stuff like this will never happen! Ha!
… or at least it won’t be my problem!
Ironic followup: UHC just sent me a letter (in the postal mail, not a website message or an e-mail) extolling the virtues of having my Tricare premiums deducted by DFAS from my pension. All I have to do is complete the enrollment form and mail it back…
OMG – what a horrible story…I’ve had my issues with TRICARE and needing some medical services while on status, but not for more than 30 days – switching between my own sponsorship versus my husband’s retired military sponsorship and the hazards of such. I’d have to run back and forth between two offices in the clinic…crazy – now there are no TRICARE admin offices, it’s all done online – can’t wait for the snafus to pile up. Your patience is amazing – or you left out the exclamations of four letter words as you waded through the crap…..
My thoughts may have been edited before publication, but UHC and Tricare only heard my most professional manners. After all, I’m retired and I have the time to do this all day. They have to go without coffee or bathroom breaks until they finish answering my questions…
What a nightmare! Glad to hear you got everything sorted out! I will say it isn’t always easier on the outside either. It took me almost 4 months to get our maternity care coverage transferred to our new policy when my wife and I moved from Ohio to Illinois. Both plans were Blue Cross Blue Shield, and there is a 12 month waiting period before you can use maternity coverage (to prevent people from signing up right when they need it, then dropping it after they have their child). Because both plans were BCBS, they were supposed to waive the 12 month waiting period in IL, since we had already done the 12 months in OH. They told us this would happen when we signed up, but we didn’t notice it until my wife started going to her obstetrician. What followed was a series of dozens of phone calls, emails, and faxes. In the end it was taken care of – literally the week we had our second child. I love the concept of having insurance. But it can be a nightmare at times.
Thanks, Ryan! I just hope we can help others avoid these pitfalls…
Thanks for sharing this, Doug. I will file it in to my “things to remember in five years” folder :)
You’re welcome, Kate, and you’ll get plenty of practice at it!
Thanks Nords, for sharing those pitfalls…always better to learn vicariously through others’ experiences. Tricare is one of those things I am slowly learning more about at retirement, although I am still my wife’s dependent (still on Active Duty) so I/we don’t yet have to navigate the “treacherous waters” of Tricare Prime for retirees, with annual enrollment fees (2 months advanced payments) and copayments. I guess we have over a year to familiarize ourselves with this.
With regards to our daughter’s Tricare insurance when she turned 21…I don’t recall this being an issue. But then again, being a cadet at one of the service academies, I suppose this was not something we had to worry about as she was already covered while attending USAFA. Still a good thing to know and not take for granted.
Thanks, Mel! Hopefully your change to Tricare Prime is seamless, and there maybe there won’t be a switch of Tricare contractors for a few years.
You’re absolutely right about service academy cadets/midshipman: Army, Navy, & Air Force have Tricare. (I’m not sure about USCGA and the Merchant Marine.) Our daughter had to learn a lot more about Tricare management (and referrals) than a college student really wants to know (or cares to discuss with her parents). This was one of those college parent situations where us parents being service academy grads was a drawback…
I have a somewhat similar situation that occurred to me and my wife when I took a job that was in the West region, and my wife was going to remain in the South region while I went through a 10 month training program. I had called both Tricare West and South, and told them what was happening, and asked what I needed to do to make coverage smooth to the West region. I was n’t worried about the South, as that was already set up through DFAS deductions.
Little did I know that my DFAS debit for the South ended, and because I had not set up a required new debit to include both South and West to cover my wife and myself, we were dropped out of Tricare. I finally received a letter at my school address from Tricare that our covergae would end in 15 days from date of letter, and that was 1 week ago. I had 3 days to fix this!!
After speaking with several Tricare agents, in both South and West I was told what to do, but also that I would be uncovered until DFAS was reset to send monthly payments. This was 2 months. Additionally, I had to resubmit, and state why I had been delinquent in payments, and had to get re-approved to participate in Tricare for both of us.
Lesson learned. Always, always make sure that if you are moving Tricare areas, speak to both regions 1 month in advance to ensure DFAS makes payments to the new region, and do not expect Tricare to automatically do this, as Iearned.
Ouch! Thanks for your comment, Gary. It’s another new lesson from Tricare that I wish nobody had to learn…
If a dependent child drops out of college mid-year (between semesters), when will his coverage be lost? I’m afraid to ask Tricare because I don’t want to red flag him.
That’s an interesting question, Michele, because Tricare’s website doesn’t show an expiration date like “3 January” or “the first month after dropping out”. However the young adult loses their Tricare eligibility the minute that they stop being a full-time college student. (https://tricare.mil/LifeEvents/College/Graduating) For your question that would presumably be when they formally withdraw from the college. It could also be the first date that they stop paying their fees or don’t show up for attendance.
A young adult (dependent child) is dropped from the DEERS database on their 21st birthday– unless the sponsor provides a “letter of attendance” from the college to verify enrollment (“full-time in an accredited college in pursuit of an Associate’s Degree or higher”, https://tricare.mil/Plans/Eligibility/Children). This DEERS drop happens even if the young adult is a full-time student taking 22 credit hours on a ROTC scholarship. Let’s not get into how I know this.
The next tripwire would be college graduation or their 23rd birthday (whichever happens first), when they age out of Tricare for college students and have to purchase their own health insurance. (https://tricare.mil/Plans/Eligibility/Children)
If a young adult drops out of college between those two birthdays, they’ll still have to have an updated address in DEERS (https://tricare.mil/LifeEvents/College/HealthCarePlans). Tricare will only have a reason to formally verify their attendance if they seek medical care. And, of course, if they claim medical benefits when they’re not eligible for that insurance policy then it’s considered fraud. Tricare would probably pay the claim but then check attendance letters and mailing addresses and start asking questions.
The answer to your question: when your young adult reaches age 21, they have to be a full-time college student to retain their Tricare eligibility. If they decide that they’re no longer a college student or if the college drops them (whichever happens first), then they’re no longer eligible for Tricare health insurance.