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Learn About TRICARE Insurance in Pennsylvania

If you are in the military, you may be wondering: “What is TRICARE?” This is particularly beneficial if you are looking for a health care program to meet your needs. TRICARE is the health care program from the United States Department of Defense (DoD) for uniformed military members, veterans and their families.

The benefits of TRICARE insurance in Pennsylvania include medical, dental and pharmacy coverage, as well as specialized programs for specific needs. Additionally, this military health program offers different plans, giving beneficiaries the ability to choose the right coverage for them. Currently, an estimated 9.4 million Americans are covered under one of these TRICARE health insurance plans. Read on to learn more about TRICARE or download our comprehensive guide.

What are the TRICARE requirements in Pennsylvania?

TRICARE eligibility is based on your relationship to the military. In general, the following applicants are eligible for some form of coverage:

  • Uniformed military service members and their families
  • Members of the National Guard or Reserves and their families
  • Survivors and former spouses of military service members
  • Medal of Honor recipients and their families
  • Individuals registered in the Defense Enrollment Eligibility Reporting System (DEERS)

If you are someone who qualifies for TRICARE in PA, keep in mind that the coverage and benefits you receive may depend on which of the above categories you belong to. Additionally, all individuals must be registered in the DEERS in order to be eligible for any coverage. Generally, military service members are automatically registered in the system. However, they will be required to register their family members individually in order for them to qualify under DEERS eligibility.

For more information on requirements, download our free comprehensive guide.

How to Apply for TRICARE in Pennsylvania

There are different TRICARE health coverage plans based on differing eligibility qualification. Likewise, the TRICARE enrollment process may vary depending on the coverage you are seeking. For example, you may enroll in TRICARE Prime and in TRICARE Select only after a qualifying life event (QLE), as well as during open enrollment in the fall. On the other hand, you do not need to sign up for TRICARE for Life.

Note: Regardless of the health plan you choose, you will be required to apply for dental coverage separately.

Generally, you can complete TRICARE enrollment online, by phone or by mail. However, you must verify which processes are available for your specific health plan because certain plans are ineligible for online enrollment. For instance, you cannot apply online for the overseas health care plans.

In order to apply by phone, you will have to locate the appropriate TRICARE enrollment number. This number can be found online by looking at individual health care plans.

To apply by mail, you will need to complete a TRICARE enrollment form. Then, you must send the completed application to the address listed on the form. In any case, make sure to choose the correct application form, because these documents may differ depending on where you live.

You can download our free guide to learn more information on how to apply for TRICARE.

Learn About TRICARE Costs and Coverage in Pennsylvania

TRICARE benefits in Pennsylvania vary based on the category of the beneficiary. Generally, TRICARE offers coverage for health care services, prescription medications, mental health services and dental care. Additionally, TRICARE coverage may include applied behavioral analysis, cancer clinical trials and hospice care.

Like coverage options, TRICARE payment amounts will vary depending on the status of the beneficiary. For instance, active duty service members do not pay any out-of-pocket expenses for any care. However, family members may have TRICARE cost shares or copays if they are on certain plans. Moreover, dental coverage requires a monthly premium that varies based on your beneficiary status.

For more information on which services TRICARE may cover for your family, download our comprehensive guide.

How to File a TRICARE Claim in Pennsylvania

In most cases, TRICARE claims in Pennsylvania will be filed by your provider, who will provide you with an explanation regarding how your care was paid for. However, there are certain instances when you must file a claim on your own, including:

  • When you travel.
  • If you get care from a non-participating provider.
  • If you are a member of TRICARE for life and see a nonparticipating Medicare provider.

To file a claim on your own, you will need to locate the proper TRICARE claims form and send it the appropriate address based on the region you received care or where you reside. After you file a claim, it should be processed within 30 days, and you will receive a TRICARE reimbursement. If your claim is denied, you may contact the claims processor and resubmit the claim if the denial was due to incorrect filing. Otherwise, you may file an appeal for your claim to be reevaluated.

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