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Learn About TRICARE Insurance in North Carolina

Every year, TRICARE provides approximately 4.6 million Americans with health insurance. Overall, this is a federal program administered by the Defense Health Agency (DHA). However, certain regulations and eligibility requirements may vary depending on the state or a service member’s location outside of the country.

In general, TRICARE insurance in North Carolina aims to support the U.S. military program and American families associated with the military. Active duty military members, retired veterans and their families may receive coverage, though their coverage costs will depend on a variety of factors. Ultimately, the goal of TRICARE is to provide comprehensive coverage. Read below to learn more about the eligibility requirements, application process and what to expect from this process.

What are the TRICARE requirements in North Carolina?

Your TRICARE eligibility in North Carolina depends mainly on whether you are a military service member or the relative of one. Generally, you will always have access to coverage if you are on active duty. For example, you may receive coverage if you fall into one of the following categories:

  • Uniformed service members
  • National Guard members
  • Reserve members
  • Former spouses of service members
  • Survivors of deceased service members
  • Children or dependents of service members
  • Medal of honor recipients

If you are unsure about your eligibility, you may partake in a TRICARE eligibility check, which usually involves a free online questionnaire. These questionnaires will typically ask about your military status or relationship to the military. Then, you will receive a list of TRICARE programs for which you may qualify.

As an example, North Carolina residents are not eligible for any overseas programs, but they may qualify for TRICARE Prime, TRICARE Select, TRICARE for Life and the U.S. Family Health Plan, among others.

Before filing your application, it is important to check the DEERS eligibility requirements and make sure that you are properly registered. The Defense Enrollment Eligibility Reporting System (DEERS) is a database of military members, their families and certain other people who are entitled to TRICARE and other benefits.

If you are an active duty or retired service member, you will be automatically entered into the DEERS system. However, your family members may not be automatically added, which means that you must add them manually. If you recently got married, you will need to submit your marriage certificate and your spouse’s birth certificate, photo ID card and certain other relevant documents in order to add him or her to the DEERS.

If you wish to do so, you may set up an appointment by calling a TRICARE eligibility phone number or your local ID card office. You can also request an appointment online.

Once your family members are registered with the DEERS, they will most likely be eligible for TRICARE. However, they may not be automatically enrolled to receive health care coverage. In these circumstances, you may need to enroll your family members separately after they have been registered for the DEERS. Get the most important information about TRICARE requirements with our free detailed guide.

How to Apply for TRICARE in North Carolina

The TRICARE enrollment process in North Carolina is straightforward. However, you must complete all the steps accurately and on time.

If you want to sign up for TRICARE Prime, you need to check whether you are in a Prime service area. Service areas are general areas in the U.S. where you could reach a nearby military hospital or clinic. If you do not live in a service area, you may need to select a different coverage option.

The TRICARE enrollment online process will be available to you if you live in a Prime service area. To do so, you must visit the beneficiary web enrollment page and follow the proper instructions. If you live outside of a service area, you may not be allowed to enroll online. In this case, you may apply by phone or by mail.

Alternatively, you may call the TRICARE enrollment number to apply by phone. To apply by mail, send your enrollment form and an acceptable payment method (if applicable) to proper regional contractor’s office. Find out how to apply for your desired TRICARE program by downloading our comprehensive guide.

Learn About TRICARE Costs and Coverage in North Carolina

TRICARE benefits in North Carolina are comprehensive. However, you may be required to pay for certain aspects of your health care depending on your relationship to the military. If you are on active duty, you are not required to make any payments for your health insurance.

Family members and dependents usually pay copayments, deductibles and enrollment fees, though these fees depend on the health care plan. Retired reserve members may also be required to pay enrollment fees.

TRICARE coverage is sorted into categories, including:

  • Primary care
  • Preventative care
  • Hospital care, surgery, urgent care and emergency care
  • Mental health and substance abuse
  • Medical equipment and supplies
  • Tests and x-rays
  • Dental and vision

With the exception of dental and vision, each of these categories has some form of care that is covered in full. For example, clinical preventive services and immunizations, which fall under preventative care, are always covered regardless of the program.

What does TRICARE cover? Ultimately, that depends on your plan and whether you receive in-network or out-of-network coverage in North Carolina.

How to File a TRICARE Claim in North Carolina

TRICARE claims may be a necessary step in receiving the coverage that you qualify for. Generally, claims are filed by your provider. If you needed medical care outside of your coverage zone, or if you visited an out-of-network doctor, you may need to file a claim yourself.

The first step in filing a claim is to fill out the TRICARE claim form for North Carolina. Once you have completed it to the best of your knowledge, send it to the proper office along with an acceptable form of payment, if applicable.

Make sure to submit your claims form as soon as possible so that you can be reimbursed more quickly for covered care and treatment. To learn more about the claims process and your chances of reimbursement, download our guide.