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Learn About TRICARE Insurance in California

TRICARE is a federal health care program for current and former military service members and their families. However, different insurance plans are available based on an applicant’s specific eligibility. Generally, TRICARE insurance offers coverage for medical expenses, dental procedures, prescription drug costs and more. Moreover, the cost of coverage also varies based on the eligibility of different applicants.

TRICARE health insurance currently covers more than 790,000 individuals in California and more than 9.4 million worldwide. Read on to learn more about TRICARE, requirements and application procedures, or download our free guide now.

What are the TRICARE requirements in California?

TRICARE eligibility in California is based on your relationship to the military. As such, you may receive TRICARE benefits if you are:

  • An active duty service member.
  • A member of the Reserves.
  • A retired service member or veteran.
  • The family member of a service or Reserves member.
  • A survivor or former spouse of a service member.
  • A Medal of Honor recipient or the recipient’s family.

In order for applicants to be eligible for any TRICARE coverage, they must be registered in the Defense Enrollment Eligibility Reporting System (DEERS). Active duty service members and members of the Reserves are automatically enrolled in the system. However, each member must register his or her family in order for them to meet the DEERS eligibility requirements.

Additionally, the type of coverage that you will receive will depend on how you are eligible for the program. If you would like to have a TRICARE eligibility check to see if and what you may be eligible for, you can reach out to the DEERS customer service. For more information on TRICARE requirements, download our free guide.

How to Apply for TRICARE in California

The TRICARE enrollment process in California will vary depending on the plan you wish to apply for. Generally, many of the plans have enrollment options online, by phone or by mail. On the other hand, plans for individuals overseas are only offered enrollment via phone or mail.

If you choose to apply by mail, it is important to select the correct TRICARE enrollment form and to send it to the right office, which may vary based on your location. Additionally, no matter which health plan you choose, you must enroll in a TRICARE dental plan separately, if you wish to have dental coverage.

You may only apply for certain TRICARE plans, such as Prime or Select, during the open enrollment season in the fall or after a qualifying life event (QLE). However, you will not need to sign up for TRICARE for Life as long as you are registered in the DEERS and already receive Medicare. Additionally, premium plans may be purchased at any time.

For more information on TRICARE enrollment, download our free guide.

Learn About TRICARE Costs and Coverage in California

TRICARE benefits cover different types of health care depending on the specific plan that you enroll in. Generally, beneficiaries can receive coverage for:

  • Medical expenses.
  • Dental procedures.
  • Vision care.
  • Pharmacy costs.
  • Mental health services.
  • Services for special needs.

It is important to check whether or not your TRICARE coverage will count toward certain desired services. For example, TRICARE has exclusions for certain mental health services including counseling (such as nutritional counseling), behavioral services related solely to weight loss/gain, diagnostic admissions and more.

The cost of your TRICARE plan will also vary based on your eligibility and the type of coverage that you choose to enroll in. For example, active duty service members make no TRICARE payment for any type of care that they receive. However, other beneficiaries may have higher TRICARE costs depending on their plan, or if they receive care without a referral.

To learn more about the potential costs and benefits of TRICARE, download our free guide.

How to File a TRICARE Claim in California

More often than not, California TRICARE claims are filed directly by your provider. However, there are certain instances where you may need to file a claim on your own, such as when traveling or receiving care from a non-participating provider.

You should file your claim as soon as possible. That being said, beneficiaries have one year to file for the care that they received in the U.S., or three years for the care that they received overseas.

You may file your claim by filling out and mailing a TRICARE claim form, or online if you are located overseas. However, make sure to select the right form and address, because your claims processor will be different based on your individual location.

Typically, TRICARE claims are processed within 30 days from receipt. If your claim has been denied and you believe that it was due to an error in the paperwork, you may refile it. Alternatively, you may contact your claims processor or file an appeal. Once your claim is approved, you will receive your TRICARE reimbursement.

To learn more about filing a TRICARE claim, download our comprehensive guide.