TRICARE YOUNG ADULT COVERAGE - 01/06/2011 Background: The Patient Protection and Affordable Care Act required civilian

health plans to provide medical coverage to children up to age 26. The Act didnt give the Department of Defense the authority to offer this benefit through TRICARE. The National Defense Authorization Act for Fiscal Year 2011 (pending signature by the President) extends dependent medical coverage up to age 26. Specifics of the National Defense Authorization Act for Fiscal Year 11 include: Unmarried dependents who age out of TRICARE at age 21 (age 23 if full-time college/university student and dependent on sponsor for more than 50% of financial support) can purchase TRICARE Young Adult coverage under any plan the sponsor qualifies for coverage. Premium based program; premiums intended to offset the full cost of coverage Excluded if child is eligible for employer-sponsored plan. What You Need to Know: TRICARE Management Activity will implement the TRICARE Young Adult program in two phases: Phase 1 Standard/Extra 120 days after legislation is signed Phase 2 TRICARE Prime/TRICARE Prime Remote (including overseas options), and Uniformed Services Family Health Plan will follow later in 2011 due to complexity of system and process changes Once TRICARE Young Adult is implemented: Qualified young adults may choose to pay premiums back to January 1, 2011 and file claims retroactively Coverage may be purchased on a month-to-month basis Qualified young adults will be able to change plans when other options become available (PrimeStandardTRS) An enrollment card will be issued once coverage is purchased Enrolled young adults may get an ID card after purchase is reflected in DEERS (not before). Worldwide coverage will be available. Children of qualified dependents wont be covered. When the young adult turns 26, he/she may purchase continued coverage under TRICAREs Continued Health Care Benefit. Information at www.tricare.mil/chcbp. The premiums will be based on commercial insurance data to cover the costs of providing care.

FAQs Program FAQs: 1. What is the TRICARE Young Adult program? The TRICARE Young Adult program extends dependent medical coverage via a premium-based program. Coverage is extended from age 21 (age 23 if full-time college/university student and dependent on sponsor for more than 50% of financial support) up to age 26 for unmarried dependents who dont have access to employersponsored health care coverage. 2. Why is implementation of the TRICARE Young Adult program taking so long? Implementing a new program may take up to a year from when the President signs the National Defense Authorization Act into law. TRICARE Young Adult Standard/Extra planning is currently operating on an accelerated implementation schedule. Staffs are busy determining all the details of eligibility, coverage and costs; designing, testing, and implementing the software and systems changes required; updating Department of Defense eligibility databases; and crafting education efforts. 3. How will the TRICARE Young Adult program work? Qualified dependents who age out of TRICARE at age 21 (age 23 if a college/university student and dependent on sponsor for more than 50% of financial support and is not eligible for employer-sponsored health care coverage) and are under age 26 can purchase TRICARE Young Adult coverage based on the sponsors eligibility and enrollment status. Monthly premiums are required under the National Defense Authorization Act. Each qualified dependent will submit his/her applications and premium payment to the regional or overseas contractor for processing. Cost shares, deductibles, and catastrophic caps will vary based on the TRICARE plan selected and the sponsors status. Initially, only TRICARE Standard/Extra will be available. Once TRICARE Young Adult is implemented, qualified dependents may choose to pay premiums back to January 1, 2011 and file retroactive claims. Its recommended that receipts for care received on or after January 1, 2011 are kept for claims processing purposes. Opportunities to purchase TRICARE Prime/TRICARE Prime Remote and Uniformed Services Family Health Plan coverage will be phased in at a later date. 4. Will TRICARE Prime options be an available under the TRICARE Young Adult program?
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Initially, only the option offered will be TRICARE Standard/Extra. Later, TRICARE Prime options will be available in Prime Service Areas and through the Uniformed Family Health Plans. All options under the TRICARE Young Adult require monthly premium payments. 5. How much will TRICARE Young Adult coverage cost? Premiums are currently being calculated and will be equal to the governments full cost of providing the benefit. Beneficiary FAQs: 1. Do I qualify for the TRICARE Young Adult program while Im covered under a student health plan offered by my school? Yes, as long as youre an unmarried dependent under the age of 26 without eligibility for employer-sponsored health care coverage. TRICARE Young Adult will act as second payer to your schools coverage. 2. Where can I get information about the TRICARE Young Adult program? We are committed to keeping you informed about your benefit. Well make new information available on our website (www.tricare.mil/TYA), at call centers, and via all of our educational materials as soon as we have more to share. You can also sign up for e-alerts at www.tricare.mil/subscriptions; look for TRICARE Young Adult under benefit updates. 3. What if I need health insurance now? Once TRICARE Young Adult is implemented and if you qualify, you may elect to pay the monthly premiums back to January 1, 2011 and file retroactive claims. Its recommended that you keep all receipts for care received on or after January 1, 2011 for claims processing purposes. If you arent sure youll qualify for TRICARE Young Adult and lost TRICARE eligibility within the last 60 days you may consider enrolling in the Continued Health Care Benefit Program. See www.tricare.mil/CHCBP for more information. 4. Im a young adult currently purchasing individual Continued Health Care Benefit Program coverage because I aged out of TRICARE. When can I disenroll from the Continued Health Care Benefit Program to purchase TRICARE Young Adult coverage?
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You may disenroll from the Continued Health Care Benefit Program when the TRICARE Young Adult program is implemented. Remember, your sponsor must still be entitled to TRICARE coverage and you must meet the requirements of being an unmarried dependent under the age of 26 not eligible for employer-sponsored health care. You will receive a prorated reimbursement for your Continued Health Care Benefit Program premiums once TRICARE Young Adult is implemented. 5. Will I need to get a uniformed service ID card if I purchase TRICARE Young Adult coverage? Yes. However, you cant get an ID card until you have purchased coverage and your purchase is reflected in DEERS.