TRICARE Prime Enrollment – Retirees and Their Family Members

TRICARE Prime es una opción de atención administrada similar a una organización civil para el mantenimiento de la salud (HMO). It is available in areas around military treatment facilities (MTF) and former base realignment and closure (BRAC) sites.

Beneficiaries enrolled in TRICARE Prime have an assigned primary care manager and may require a prior authorization and/or referral for specialty care.

Los beneficios, costos compartidos y deducibles dependen del estado del patrocinador.

Elegibilidad

Those eligible for TRICARE Prime include:

In addition, beneficiaries must be registered in the Sistema de informes de elegibilidad para inscripción de la Defensa (DEERS) and must choose a PCM where TRICARE Prime is offered.

Consulte nuestras Determining TRICARE Prime Availability page to determine if you reside in a Prime Service Area.

Tarifas de inscripción

Retired service members and their family members have an annual enrollment fee for TRICARE Prime and the first quarterly payment is due with the enrollment application.

Consulte nuestras TRICARE Prime Enrollment Fee page to determine your enrollment fee. Review Make a Payment and Payment Options para conocer sus opciones de pago en el futuro.

Inscripción en TRICARE Prime

You may enroll in TRICARE Prime by:

          Health Net Federal Services, LLC
          PO Box 2637
          Virginia Beach, VA 23450-2637
          Fax: 1-888-299-4114

  • telephone at 1-877-TRICARE (1-877-874-2273), Monday through Friday, 7:00 a.m.–7:00 p.m. (ET).

Note: Be sure to include a three-month payment with your enrollment application.

Inscripción dividida

Members of the same family may be enrolled in TRICARE Prime in different regions. Una sola región facturará la inscripción de toda la familia. La inscripción del patrocinador determina qué región recibe el pago.

  • The region where the sponsor is enrolled is the lead contractor and will bill for the entire family.
  • If the sponsor is not enrolled, the region with the oldest enrolled family member is the lead contractor and will bill for the entire family.

Everyone on the account will be disenrolled for non-payment if payment is not received. Obligatoriamente, se aplicará un bloqueo de 12 meses si usted ha sido dado de baja por falta de pago.

Asegúrese de actualizar su información de inscripción dividida con el contratista regional de cada uno de los familiares.

New Enrollment Effective Date

TRICARE Prime enrollment applications follow the 20th of the month rule, meaning applications received on or before the 20th of the month are effective the first day of the next month.

Exceptions to the 20th of the month rule are discussed under the Adding a Newborn or Adopted Child, Change in Status and Moving with TRICARE Prime sections below.

Adding a Family Member (except a newborn or adopted child)

Your family member is not automatically covered by TRICARE Prime. To make sure your family member is enrolled in TRICARE Prime, you must complete two steps:

Your family member will be covered automatically under TRICARE Standard. Enrollment into TRICARE Prime will follow the 20th of the month rule. 

Note: Retiree accounts with only one person enrolled with TRICARE Prime will be changed from an individual to a family plan. You must submit a full quarterly payment for your application to be processed. Su próximo resumen de facturación se ajustará al monto familiar trimestral. Also, if you have an automatic payment option, it will be updated to the monthly family amount after the quarterly payment applies to your account. 

Adding a Newborn or Adopted Child

If a family member is enrolled in TRICARE Prime, a newborn or adoptee will be treated as a TRICARE Prime beneficiary as of the day of birth or adoption. Formal enrollment in TRICARE Prime is required within 60 days. If a TRICARE Prime request is received by Health Net within 60 days from the date of birth or adoption, the child is considered TRICARE Prime from on the first of the month following the date of birth or adoption.

To ensure your child has continuous TRICARE Prime coverage after the first 60 days, you must complete two steps:

If the TRICARE Prime enrollment request is not received within 60 days of your child's date of birth or adoption, then his or her TRICARE Prime coverage will end on day 60. Applications received after day 60 will follow the 20th of the month rule.

Note: Retiree accounts with only one person enrolled with TRICARE Prime will be changed from an individual to a family plan. You must submit a full quarterly payment for your request to be processed. Your next billing statement will be adjusted to the quarterly family amount. Also, if you have an automatic payment option, it will be updated to the monthly family amount after the quarterly payment applies to your account. 

Cambio de estado

A new TRICARE Prime enrollment request is required when your status changes in DEERS.

Active duty to retired:

A TRICARE Prime enrollment request must be received within 30 days* of the sponsor's retirement to qualify for continuous coverage. Family members must have been enrolled with TRICARE Prime on the sponsor's last day of active duty orders to qualify for continuous coverage. The sponsor does not have to be enrolled while on active duty orders to qualify for continuous coverage. Requests received more than 30 days after the sponsor's retirement will follow the 20th of the month rule.

*The request can be received up to 30 days prior to the retirement date and up until 30 days after the retirement date to qualify for continuous coverage.

Cobertura para sobrevivientes

Benefits do not change if your retired sponsor passes away. Surviving spouses remain eligible for TRICARE retiree benefits as long as they do not remarry. Children up to age 21, or 23 if a full-time student, are eligible for TRICARE retiree benefits and costs until TRICARE eligibility ends due to age limits or another reason, such as marriage.

For information, visit TRICARE’s survivor Ver historial de pagos.

Mudarse con TRICARE Prime

Su nueva dirección puede tener distintas opciones de TRICARE. See our Determining TRICARE Prime Availability page to see if TRICARE Prime is available in your new area. You must disenroll from TRICARE Prime if you move to an address outside of a TRICARE Prime Service Area and you do not wish to travel to a TRICARE Prime Service Area for care.

If you are already enrolled in the TRICARE North Region and move within the TRICARE North Region, update your address in DEERS and request a PCM change, if necessary.

If you are changing TRICARE regions, you can transfer your enrollment online, by mail or telephone. Your enrollment will be effective the date your request is received or six days from the date the request is submitted online through Inscripción de beneficiarios en la Web. You are limited to two enrollment transfers between TRICARE regions each enrollment year.

Pagos

Your account must be paid current before your application will be processed. Si paga a través de:

  • Allotment - your allotment will transfer with you. Payment is not required to transfer your enrollment.
  • Electronic funds transfer (EFT) or recurring credit card (RCC) - your EFT or RCC will not transfer. You must make a quarterly payment to Health Net Federal Services, LLC and request a new EFT or RCC. Follow up with your previous TRICARE contractor to stop your previous EFT or RCC.
  • Quarterly payments – you will be billed when your next payment is due.

For more information about moving, see our Mudarse con TRICARE Ver historial de pagos.

Darse de baja de TRICARE Prime

Voluntary disenrollment

La política de TRICARE establece un bloqueo obligatorio de 12 meses de TRICARE Prime luego de darse de baja en forma voluntaria. You may re-enroll with TRICARE Prime 12 months after the disenrollment effective date. No se reembolsarán los cargos de inscripción.

El bloqueo de 12 meses no se aplica si se da de baja en la renovación anual antes del 30 de septiembre.

You may disenroll:

The requested disenrollment date should be written on the form (up to 30 days in the future or 30 days in the past [from the date of receipt]). If a date is not provided, the disenrollment will be processed effective the paid through date. You will be covered under TRICARE Standard the day after your disenrollment effective date.

Disenrollment for non-payment

Your TRICARE Prime account will be disenrolled if payment is not received within 30 days from the payment due date. La política de TRICARE establece un bloqueo obligatorio de 12 meses de TRICARE Prime una vez que se le dio de baja por falta de pago. You may re-enroll with TRICARE Prime 12 months after the disenrollment effective date. 

Lista de inscripción

Asegúrese de que su inscripción esté completa. Revise la lista de control de inscripción para obtener ayuda.