The United States government provides health insurance to military service members and their families through a program known as TRICARE. Beneficiaries of TRICARE insurance may obtain coverage for medical, dental and pharmacy expenses. However, the exact coverage will depend on the specific plan. Overall, plans will range from individual plans to family plans and will vary depending on each applicant.
TRICARE health insurance has different enrollment processes based on the desired plan and location of the beneficiary. Despite the fact that TRICARE is a federal program that doesn’t differ from state to state, you may have to send application materials to different offices depending on where you live. Read on for more information about TRICARE, or download our free guide.
What are the TRICARE requirements in Texas?
TRICARE eligibility in Texas is determined based on your relationship to the military. The following individuals are eligible for some form of TRICARE coverage:
- Active duty or retired service members and their families
- Current or retired National Guard members and their families
- Survivors and former spouses of service members
- Medal of Honor recipients and their families
- Any other individual legitimately registered in the Defense Enrollment Eligibility Reporting System (DEERS)
All individuals must be registered in the DEERS in order to receive any form of TRICARE coverage. Service and reserve members, active or retired, are automatically enrolled in the DEERS. However, they must register their eligible family members in order for the family to meet the DEERS eligibility requirements.
You can get more information on TRICARE requirements by downloading our free guide.
How to Apply for TRICARE in Texas
Despite the fact that general application processes vary depending on the plan, you can typically complete TRICARE enrollment online, by phone or via mail. However, it is important to check that your plan of choice is available through each application method. For example, individuals seeking coverage overseas may only sign up for TRICARE by phone or by mail.
Regardless of the application method of your choice, it is important to gather the proper materials for TRICARE enrollment. Keep in mind that there may be a different TRICARE enrollment form and mailing address depending on where you live and what plan you are applying for.
Certain plans, such as TRICARE Prime and TRICARE Select, are only available during open enrollment periods in the fall or after a qualifying life event (QLE). However, TRICARE premium plans may be purchased at any time.
For more detailed information on how to apply for TRICARE, download our free guide.
Learn About TRICARE Costs and Coverage in Texas
Your potential TRICARE benefits will depend on the plan that you choose. However, the following benefits are commonly available through the TRICARE health program:
- Pharmacy/drug coverage
- Medical, dental and vision care
- Services for special needs
- Mental health services
It is important to be aware of any requirements that may be necessary before using your TRICARE coverage in Texas. For example, you may need to receive a referral in order to receive specialized medical services or mental health services.
Much like the nature of the benefits, each TRICARE payment may vary depending on the kind of plan you choose and the kind of beneficiary that you are. For instance, active duty service members never pay for any kind of care that they receive, but their relatives may need to pay for certain services. Additionally, service members may have to pay higher TRICARE costs if they receive out-of-network care, or if they don’t obtain the necessary referrals.
For more information regarding the costs and coverage of TRICARE, download our free guide.
How to File a TRICARE Claim in Texas
Most times, a provider will file a TRICARE claims on your behalf. However, if you are traveling or receive care from a nonparticipating provider, you will be responsible for filing the claim yourself.
In order to file a claim, be sure you select the correct TRICARE claim form and send it to the proper claims processor. Different processors are assigned based on where you live.
In general, claims for care received in the U.S. should be filed within one year. Alternatively, claims for care received overseas should be filed within three years. In any case, it typically takes 30 days for a new claim to be processed after receipt.
If your claim is denied due to an error in the original paperwork, you may refile it. Otherwise, you may contact your claims processor or file an appeal. Once your claim is approved, you will receive your TRICARE reimbursement.
Download our free guide for more details on filing TRICARE claims.