This blog is the most recent in a series helping members of the Coast Guard family understand how to use their TRICARE benefits. The blog series will continue every Monday, right here on Coast Guard All Hands.
Written by Cmdr. Paul Fawcett
If you have an adult child that remains dependent on you for support, they may be eligible for TRICARE benefits. Read on to see if your child qualifies, and if so what benefits that they may be entitled to.
In order for your child to qualify to remain your eligible dependent after age 21, or age 23 if a full time student, they must be declared as “incapacitated”. In order to meet these criteria they must be incapable of providing their own support and dependent on their TRICARE sponsor for over 50 percent of their support. Additionally the incapacitation must have occurred before age 21 or age 23 if a full time student. Your child must also be unmarried. If they are married and become unmarried you can apply for reinstatement of benefits.
Applying for Incapacitated Status
Incapacitation status and its attendant benefits aren’t automatic; you’ll need to apply for them. The Coast Guard instruction governing the determination of eligibility is COMDTINST M5512.1A: Identification Cards for members of the Uniformed Services, Their Eligible Family Members and other Eligible Personnel. According to this instruction you’ll need to present a determination of non-eligibility for part A MEDICARE benefits from the Social Security Administration. You’ll also need their birth certificate, and a form DD 137-5; Dependency Statement; Incapacitated Child over Age 21. You’ll take these documents to your servicing ID card office to apply for your dependent’s enrollment to DEERS and issuance of their ID card. Due to the complex nature of these cases, you should inform the ID card office of what you are applying for when you make your appointment, to ensure you have all required documents when you have your appointment.
TRICARE Benefits for INCAPACITATED Adult Dependents
Once your child is registered in DEERS as incapacitated, they become eligible for premium free TRICARE benefits. Your TRICARE benefits for your incapacitated adult child may include the Extended Health Care Option (EHCO) if your child meets the criteria. Benefits to this program may include up to eight hours a day/five days a week of respite care for primary care givers of severely incapacitated dependents. Normal eligibility is capped at age 21 or 23 for college students, but it may be extended if your child meets the eligibility. Other benefits may include home health care, assistive technology, and incontinence supplies.
If your incapacitated child must travel for specialty care beyond 100 miles from their Primary Care Manager, they may be eligible for travel reimbursement for themselves and one non medical attendant. The Prime Travel Benefit program is designed to cover those expenses for required medical travel in these cases including lodging, per diem, travel costs. See our previous blog post for in depth discussion of this topic. Please be aware that the Coast Guard manages the Prime Travel benefit differently than the Department of Defense. Be sure to contact the Coast Guard Prime Travel Benefit team at D11-HSWLSC-PTBREQUEST@USCG.MIL or 510-637-1214 for information.
To determine the program that your incapacitated child will be covered under and its policies, you may contact your regional TRICARE contractor at:
- TRICARE North
- Health Net Federal Services 1-877-TRICARE
- TRICARE South
- Humana Military 1-800-444-5445
- TRICARE West
- United Health Care 1-877-988-WEST
For more information on the incapacitated adult child benefits program, see the defense manpower data center Adult Child Benefits brochure.
Having TRICARE billing problems? Cant’ find a Primary Care Manager that accepts your TRCIARE plan? Call or email the Coast Guard Health Benefits Assistance Line for help 1-800-9-HBA-HBA or CGHBA@uscg.mil.