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Tricare Help: Covering parents under TRS is a long shot

May. 26, 2013 - 03:42PM   |  

Q. I recently enlisted in the Army National Guard. I will leave for basic combat training and advanced individual training in a month. When do my benefits begin under Tricare Reserve Select? Could my parents be covered by it? They’re in their late 50s, and my dad just lost his job.

A. Dependent parents are eligible for Tricare only in limited and specific circumstances. To start with, they must be the service member’s legal dependents; that is, they must be living with their military sponsor and be dependent upon him or her for more than 50 percent of their support. And even then, their Tricare coverage is limited; they are generally eligible for care only through on-base military treatment facilities, and then only if space and resources are available. Unfortunately, you will not be able to cover your parents under Tricare Reserve Select.

As far as you are concerned, for the duration of your time in basic training and advanced individual training, you will be fully covered by the military for all of your health care needs. You do not need to begin paying the Tricare Reserve Select monthly premiums until after you finish AIT and transition to drilling status. TRS coverage can be purchased any time during the year. To enroll, you need to fill out an application and submit it to the Tricare managed-care contractor for the Tricare region in which you live. The application must be postmarked no later than the last day of the month before you want your coverage to begin. You want to time it so that your TRS coverage begins the month after you complete AIT and transition to drilling status.

You can find more information about TRS at www.tricare.mil/trs.

Q. Can I use Tricare to pay for another health insurance plan’s deductible, or do I have to meet the deductible first before Tricare will pay anything?

A. After a beneficiary’s other health insurance, or OHI, processes a claim, Tricare will pay what’s left, up to the “Tricare allowable charge,” which is the maximum amount Tricare will authorize for medical and other services furnished in an inpatient or outpatient setting. In general, the result is that Tricare pays some, if perhaps not all, of the OHI’s deductible and co-payments.

Assuming you are using Tricare-network (contracted) providers or non-network providers who accept Tricare (participating providers), the way payments with OHI are calculated is that Tricare will pay the lowest of these three amounts:

* The billed amount minus the OHI payment.

* The amount Tricare would have paid without the OHI.

* The amount the beneficiary owes after the OHI pays (usually the OHI co-payment or cost share).

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.

Answers by RallyPoint

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