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Learn About TRICARE Insurance in Illinois

TRICARE is a military health program offered by the United States Department of Defense (DoD). The TRICARE insurance program covers more than 9.4 million beneficiaries, including almost 150,000 residents in Illinois. Beneficiaries can receive coverage for:

  • Medical expenses.
  • Prescription drug costs.
  • Dental procedures.
  • Mental health services.
  • Health services for special needs.

TRICARE insurance in Illinois is available to both active and former service members and their families. However, the actual coverage available depends on which particular beneficiary category the applicant falls into.

Likewise, the cost of TRICARE varies depending on the beneficiary’s eligibility and chosen plan. Read on to learn more about TRICARE health insurance, or download our comprehensive free guide now.

What are the TRICARE requirements in Illinois?

TRICARE eligibility in Illinois is dependent upon an applicant’s relationship to the military. As such, the following residents are eligible for TRICARE coverage:

  • Military and National Guard members and their families
  • Member of the Reserves and their families
  • Survivors and former spouses of military members
  • Recipients of the Medal of Honor and their families
  • Other individuals who are registered in the Defense Enrollment Eligibility Reporting System (DEERS)

All individuals must be registered in DEERS in order to receive any TRICARE benefits. Active duty military service members are automatically enrolled in the system, but they must register each of their family members before they can meet DEERS eligibility.

There is a TRICARE eligibility phone number available for you to ask any questions regarding your general eligibility for DEERS and TRICARE. You can also access a comprehensive breakdown of these requirements by downloading our guide.

How to Apply for TRICARE in Illinois

TRICARE enrollment in Illinois varies depending on the type of coverage you are seeking and the category of beneficiary to which you belong. For instance, you may only be able to sign up for TRICARE Prime and TRICARE Select during open enrollment periods or after a qualifying life event. Alternatively, premium TRICARE plans may be purchased at any time.

In most cases, you may apply for TRICARE coverage online, by phone or by mail. However, be sure to check the available methods for the specific plan you would like to enroll in. Plans designed for individuals overseas do not offer TRICARE enrollment online. Instead, you must enroll in these plans by mail or by phone.

For more detailed information on how you may enroll in TRICARE, download our comprehensive guide.

Learn About TRICARE Costs and Coverage in Illinois

The TRICARE benefits available to recipients may vary depending on the plan that they enroll in. In general, these plans may include coverage for:

  • Medical expenses.
  • Prescription drug costs.
  • Mental health services.
  • Special needs services.
  • Vision care.

The ability for applicants to obtain any of the abovementioned services depends on the TRICARE coverage plan that they choose, as well as the type of beneficiary that they are. For example, active duty military service members must receive a referral and prior authorization for all mental health services. However, non-active duty beneficiaries only need a referral and prior authorization for psychoanalysis and outpatient therapy for substance abuse.

TRICARE payment amounts will also vary depending on both the plan and the beneficiary. Active duty service members do not pay for any type of care they receive under the health insurance program. On the other hand, family members may need to share TRICARE costs when using certain services. Additionally, higher costs may be applied for using out-of-network providers.

Download our free guide to learn more about which costs may be associated with TRICARE coverage.

How to File a TRICARE Claim in Illinois

TRICARE claims are typically filed by your health care provider. However, there are certain instances, such as when traveling or receiving care from an out-of-network provider, that you may need to file a claim on your own.

If you wish to receive TRICARE reimbursement, you must file claims for care received in the United States within one year. For care received overseas, you must file a claim within three years.

Claims are usually processed within 30 days. In any case, it is important to fill out the correct TRICARE claim form and send it to the proper address. Depending on your location, you will be required to send claims to a different processor. Additionally, be sure to complete the entire form thoroughly, as mistakes can result in the denial of your claim.

If your claim is denied due to incorrect filling, you may refile it. In other instances of claim denial, you may contact your processor and file an appeal.

For more information on how to file a TRICARE claim, download our free guide.