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Hi everyone! I'm Jennifer and my husband and I just took custody of our adoptee daughter on 22 July when she was born. We attempted to get medical benefits for her and the state and the county both denied her medical saying that we made too much in the military. So we called tricare and explained our information and the supervisor there gave us the following advice. If you can't get immediate medical for your adoptee child you can register them like you normally would, schedule their appointments and attend like usual. When the hospital submits the forms they will be rejected and sent back but you can resubmit them after the adoption is final and they should be accepted by tricare. We haven't tried this yet, since we found a retired Army Doctor who is willing to work with us. But I will post back when I find out how it works for us. Hope this might be helpful to someone. *** I guess I should mention that we aren't going through an agency. From what I understand this is typically taken care of by agencies since they are state representatives.
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Actually, Tricare should cover the adopted child before the adoption is final, I believe there are federal laws in place which state as much. Coverage should start the minute you take legal custody. Once you have custody and guardianship, which is what you will have between the time you take custody and the time the adoption is final, all you have to do is apply for coverage and show the documentation that you have saying that you are her guardian. Its really very simple, although they will more than likely make you fight for it, Tricare is fun like that. Maybe someone here can post reference to the law regarding insurance covering adopted children before finalization. In some states, it takes more than a year to finalize, which is why laws like these were passed.
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[font=Book Antiqua]Jennifer, I am going to post a lot of information, because the info you were given could jeopardize coverage for your child and in the end, cost you a lot of money.[/font] [font=Book Antiqua]Here, I found this information regarding Federal Law:[/font] [font=Book Antiqua]Federal law requires that group health plans that provide coverage for "natural" children must provide the same coverage for adoptive children, to begin when children are placed for adoption. The specific law in question is Section 609(c) of the Employee Retirement Income Security Act of 1974 (ERISA). This law is succinctly described in the article "Medical Coverage for Adopted Children", by Michael S. Melbinger. Mr. Melbinger, an attorney with Chicago-based law firm Winston & Strawn, has done substantial pro bono work for Adoptive Families of America (AFA). [/font] [font=Book Antiqua]Basically, once the child is entered in to DEERS, which can be done after you take custody and relinquishment has been signed, you can submit the application for Tricare. They will only cover the medical expenses accrued AFTER the termination of parental rights. [/font] [font=Book Antiqua]From the Department of Labors website:[/font] [font=Book Antiqua]Important Facts When Adopting [/font][font=Book Antiqua]Contact your health plan or your spouses health plan as soon as possible to find out how to enroll your child in group health plan coverage. [/font] [font=Book Antiqua]As long as you enroll your child within 30 days of adoption or placement for adoption, coverage should be effective as of your childҒs adoption or placement date and your child cannot be subject to a preexisting condition exclusion. [/font] [font=Book Antiqua]Remember, you should enroll your child within 30 days of the date of adoption or placement for adoption.[/font] [font=Book Antiqua]From the website of the DEERS/Tricare Website: [url="http://www.tricare.osd.mil/deers/newborn.cfm"]http://www.tricare.osd.mil/deers/newborn.cfm[/url][/font] [font=Book Antiqua][/font][font=Book Antiqua]Enrolling Your Newborn or Newly Adopted Child in TRICARE Prime/TPRADFM[/font][font=Book Antiqua]Newborns are covered as TRICARE Prime beneficiaries for 60 days after birth ("deemed TRICARE Prime"), as long as one person in the family is enrolled in TRICARE Prime, then... [/font][list][*][font=Book Antiqua]TRICARE Prime or TPRADFM benefits end after 60 days, and future claims will process as TRICARE Standard (higher costs) until 365 days after the child's birth. On day 366, DEERS will show "loss of eligibility," and the child will no longer be able to receive any TRICARE benefits. [/font][*][font=Book Antiqua]If a family wants to continue TRICARE Prime/TPRADFM/TOPP coverage after the first 60 days following birth or adoption, the family must submit a completed TRICARE Prime enrollment application in enough time for it to be processed by the 60th day of life/custody. Think about submitting the enrollment no later than 40 days after birth/custody) to allow Prime coverage to continue without a break. [/font][*][font=Book Antiqua]60-Day Waiver: If an sponsor/legal is unable to get a completed application submitted before the 60-day deemed Prime coverage ends due to their own extreme illness, legal issues, etc., the family can request a waiver of the 60-day requirement and ask that Prime coverage continue for another 60 days while a formal enrollment application is obtained, submitted, and processed. [/font][*][font=Book Antiqua]The Director of each TRICARE Regional Office (TRO) and the Deputy Directors of each TRICARE Overseas Office may extend the 60-day deemed Prime enrollment period from 60 up to 120 days on a case-by-case or regional basis for unique issues [/font][*][font=Book Antiqua]Parents/legal guardians should submit a waiver request {link to letter template here]to the appropriate TRICARE Regional Office [/font][list][*][font=Book Antiqua]For TRO South TRICARE Regional Office SouthAttn: Enrollment Section7800 IH 10 WestSuite 400San Antonio, TX 78230or faxed at (210) 292-3222. [/font][*][font=Book Antiqua]For TRO North TRICARE Regional Office NorthAttn: Enrollment Section5111 Leesburg PikeSuite, 810Falls Church, VA 22041-3201or fax to (703) 681-1940 [/font][*][font=Book Antiqua]For TRO West TRICARE Regional Office WestAttn: Enrollment Section401 West "A" Street Suite 2100San Diego, CA 92124or fax to (619)-231-4246 [/font][/list][/list][font=Book Antiqua]A Special Note for Newborns or Newly Adopted Children Overseas [/font][font=Book Antiqua]TRICARE officials in overseas locations extends the period of coverage-without-formal enrollment to up to 120 days on a regional basis[/font][font=Book Antiqua] [/font][font=Book Antiqua]Who is Eligible for Tricare [url="http://www.tricare.osd.mil/News/1997/news97_26.htm"]http://www.tricare.osd.mil/News/1997/news97_26.htm[/url][/font] [font=Book Antiqua][/font][font=Book Antiqua](8) Dependent wards placed in the custody of a service member or former member, either by a court or by a recognized adoption agency, for a period of at least 12 months. TRICARE eligibility is effective July 1, 1994, if the child is placed by a court. A child placed by a recognized adoption agency is eligible effective on the date the child is placed by the agency, or on Oct. 5, 1994, whichever date is later;[/font] [font=Book Antiqua]Jennifer, I hope this information helps you get the coverage you need! Make the DEERS appointment tomorrow and if the birthmother has already terminated her parental rights, fill out the Tricare PRIME application[/font] [font=Book Antiqua]PDF File below of the form you need! Remember to have it notarized! [/font] [font=Book Antiqua]DD1172: [url="http://www.dtic.mil/whs/directives/infomgt/forms/eforms/dd1172-2.pdf"]http://www.dtic.mil/whs/directives/infomgt/forms/eforms/dd1172-2.pdf[/url][/font] [font=Book Antiqua]Find your local DEERS and Tricare Service Center: [/font][url="http://www.dmdc.osd.mil/rsl/owa/home"][font=Book Antiqua]http://www.dmdc.osd.mil/rsl/owa/home[/font][/url]
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My son was an independant adoption and once the court gave us papers relinquishing the bparents rights DEERs took him on even though he was not legally adopted. I had guardianship of him bit no finalized adoption. tricare has seen him tons with no issues and he is now 14 months
Derek's Wife
The state has strange laws regarding adoption. So that doesn't happen until the adoption is finalized, unfortunately. Which is why we were instructed to do tricare that way. Sucks to be us.