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TRICARE Prime Enrollment – Retirees and Their Family Members

Overview

TRICARE Prime is a managed care option similar to a civilian health maintenance organization (HMO). It is available in areas around military hospitals and clinics 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.

Eligibility

Those eligible for TRICARE Prime include:

In addition, beneficiaries must be registered in the Defense Enrollment Eligibility Reporting System (DEERS) and must choose a PCM where TRICARE Prime is offered.

Please refer to our Determining TRICARE Prime Availability page to determine if you reside in a Prime Service Area.

Enrolling in TRICARE Prime

You may enroll by:

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

Beneficiaries who remain eligible will be automatically re-enrolled each year unless they elect a different option or disenroll during the open enrollment season.

Changes in enrollment can only be made during the open enrollment season or within 90 days of a qualifying life event (see below). Visit our TRICARE Open Season page to learn more. 

Split Enrollment

Members of the same family may be enrolled in TRICARE Prime in different regions. Only one region will bill for the entire family enrollment. Individual and family enrollment fees for TRICARE Prime are separate from individual and family enrollment fees for TRICARE Select. The sponsor's enrollment determines which region receives the payment.

  • 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. 

Make sure to update your split enrollment information with each family member's regional contractor.

Effective Dates

If you enroll in TRICARE Prime during TRICARE's Open Season, your enrollment is effective January 1 of the following year. Enrollment due to a qualifying life event (QLE), such as adding a newborn, is effective the date of the QLE.  

Fees

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. Enrollment fees are subject to change each calendar year (Jan. 1–Dec. 31). 

Type of Coverage Group A* Group B*
Member Only 2018: $289.08
2019: $297.00
2018: $350.00
2019: $360.00
Member and Family 2018: $578.16
2019: $594.00
2018: $700.00
2019: $720.00

 

Note: Rates are subject to change every calendar year.

Review Make a Payment and Payment Options for future payment information.

*A beneficiary’s group category is determined by the sponsor’s initial enlistment or appointment date:

  • Group A: Sponsor’s enlistment or appointment date occurred prior to Jan. 1, 2018.
  • Group B: Sponsor’s enlistment or appointment date occurred on or after Jan. 1, 2018.

Failure to pay the total amount due will result in disenrollment from TRICARE Prime. Your disenrollment will be effective the day following your policy paid-through date. Once disenrolled from TRICARE Prime, you will be only eligible for coverage at the military hospital/clinic under direct care if space is available. Claims for services after your disenrollment date will not be paid under your TRICARE Prime coverage. 

Qualifying Life Events (QLEs)

A change in your or a family’s member life may affect your TRICARE enrollment options. This is known as a qualifying life event, or QLE. View the QLE chart below for additional information. 

If you would like to make an enrollment change, the request must be made within 90 days following the QLE. 

Qualifying Life Event Additional Information
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:

  • Update your family member’s eligibility in DEERS by visiting a RAPIDS site.
  • Submit an enrollment request to HNFS (see above) within 90 days of the QLE.

Note: Retiree accounts with only one person enrolled in 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. 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. 

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 90 days. To ensure your child has continuous TRICARE Prime coverage, you must complete two steps:

  • Update your child’s eligibility in DEERS by visiting a RAPIDS site within 90 days.
  • Submit an enrollment request to HNFS (see above) within 90 days of your child’s date of birth or adoption.

If the DEERS update and TRICARE Prime enrollment request are not received within 90 days of your child’s date of birth or adoption, then previously paid claims during the first 90 days will be recouped and he/she will not be eligible for TRICARE Prime coverage.  

Note: Retiree accounts with only one person enrolled in 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. 

Change in Status

A TRICARE Prime or TRICARE Select enrollment request must be received within 90 days of the sponsor's retirement to qualify for continuous coverage. Retirees who don't enroll in a TRICARE plan with 90 days will only be eligible for health care in a military hospital or cilnic under direct care if space is available. 

Retirees can request enrollment up to 90 days prior to the retirement date and up until 90 days after the retirement date to qualify for continuous coverage.

Death in the Family

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 page.

Moving 

Your new address may come with different TRICARE options. See our Determining TRICARE Prime Availability page to see if TRICARE Prime is available in your new area. You must enroll in either TRICARE Prime (moving to a PSA) or TRICARE Select to have coverage.

If you are already enrolled in the TRICARE West Region and move within the TRICARE West 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 within 90 days of your move. Your enrollment will be effective the date the request is received. 

Payments

Your account must be paid current before your application will be processed. If you pay by:

  • 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 HNFS 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 Moving with TRICARE page.

Children Going to College or Becoming an Adult See our TRICARE Young Adult page.

Other QLEs also include getting divorced, becoming Medicare-eligible, a loss or gain of other health insurance, and government-mandated plan or PCM changes. 

Disenrolling from TRICARE Prime

Voluntary disenrollment: You may voluntarily disenroll from TRICARE Prime. However, eligible beneficiaries not enrolled in a TRICARE plan are only covered for care at the military hospital or clinic under direct care if space is available. Beneficiaries can only re-enroll during the open enrollment season and/or in the event of a QLE.

You may disenroll by:

If voluntarily disenrolling, you can request a specific disenrollment date. Otherwise, the disenrollment will be effective the day after your paid-through date.

Non-payment: If HNFS does not receive your premium payment within 30 days from the due date, you will be disenrolled for failure to pay. If you are disenrolled for failure to pay, you will be suspended from TRICARE Prime effective your paid-through date and any claims for services after your suspension date will not be paid under your TRICARE Prime coverage. 

Reinstatement

If you have been disenrolled for failure to pay for less than 90 days, you may be reinstated. Full payment is required to bring the policy current. If disenrolled greater than 90 days, you will be eligible for enrollment at the next open enrollment season or when a QLE occurs.