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TRICARE Health Benefits

Legal Authorities:

45 CFR  302.33, 302.56, 303.7, 303.30, and 303.31

36 O.S. § 6058A

OAC 340:25-5-168 ITS

OAC 340:25-5-171 ITS

OCSE PIQ-06-02

Overview

Military members are provided a health benefit through TRICARE. This benefit is made through the Defense Enrollment Eligibility Reporting System (DEERS). Active-duty and retired service members are automatically registered in DEERS, but additional action is required to enroll eligible dependents.

TRICARE provides health benefits to approximately 9.5 million beneficiaries around the world. These beneficiaries include individuals, who are currently serving in the United States military, members of the National Guard and Reserve, individuals, who have retired from work and families of people who have retired from their posts in the United States military. In addition to this, these facilities are also extended to survivors as well as former spouses or any other individuals who have been registered or enrolled in DEERS, which is the Defense Enrollment Eligibility Reporting System.

TRICARE Eligibility

The Office of Child Support Services (OCSS), Policy Interpretation Question (PIQ) has advised states not to send the National Medical Support Notice (NMSN) if the noncustodial parent is active duty or retired military. (See OCSS PIQ-06-02, Guidance for Sending the National Medical Support Notice to the Defense Manpower Data Center.) Reservists are not entitled to TRICARE eligibility until 30 days of active duty. A reservist/noncustodial parent may be employed elsewhere. You can potentially learn of a reservist’s place of employment by means of a quarterly wage or new hire reporting match from the Federal Parent Locator Service (FPLS). You may then send the NMSN to that employer.

How TRICARE Information is Received by CSS

Federal Case Registry (FCR) data are sent to the Defense Manpower Data Center (DMDC) for matching. DMDC matches the FCR participants with its records and indicates which children are eligible and enrolled for TRICARE. DMDC then sends the health benefits matching information to CSS. There are three CMOD reports with these data. They are:

  • CY909R01, The Child is Currently Enrolled in Medical Coverage. Child Support Specialist should update the Third Party Liability (TPL) screens to document this coverage.
  • CY909R02, A Child is Eligible Based on the CP or NCP/PF (Noncustodial Parent/Putative Father) Current Medical Coverage, But is Not Enrolled. The MEDTRI letter should be sent to the custodian to inform him/her health coverage for the child(ren) is available and how to contact the military to start the enrollment process. A National Medical Support Notice (NMSN aka MED5) is not sent to the military. The military member or the custodian must contact the military for enrollment to occur.
  • CY909R03, A Child was Previously Enrolled but Not Currently Enrolled and Neither a CP nor NCP/PF is Enrolled. Child Support Specialist should update the Third Party Liability (TPL) screens to document the lapse of coverage.
Note:
See CSQuest article What OKESC Updates When Documents Return for more information for information on TPL screens.

TRICARE FAQs

Q: What are DEERS and TRICARE?
A: Military members are provided a health benefit through TRICARE. This benefit is made through the Defense Enrollment Eligibility Reporting System (DEERS). Active-duty and retired service members are automatically registered in DEERS, but additional action is required to enroll eligible dependents.

See OAC 340:25-5-168 ITS and OAC 340:25-5-171 ITS

Q: Should cash medical be terminated when the child is enrolled in TRICARE?
A: Yes, termination of cash medical can be appropriate when CSS has received verification that the child is enrolled in alternative coverage such as TRICARE. Send a Notice of Proposed Termination of Cash Medical Support (CM01 for the NCP version, and CM02 for the CP version) to all parties in the case by regular mail. Parties have 10 days from the date of mailing to request a review.
Q: I looked at POLA, but the TRICARE policyholder is someone other than the obligor (see example below). Should we still terminate cash medical?
A: Yes, when a child is enrolled in TRICARE, the CM01 and CM02 should be sent, regardless of who is listed as the service member associated with the coverage.

Screen print of the CPOL screen.

Q: Does the CM01 and CM02 generate automatically once a policy is added to OSIS?
A: Not necessarily, if the policy holder is someone other than the NCP, the CM01 and CM02 will have to be manually generated:

  • CSCD (sp) CM01U
  • CSCD (sp) CM02
Q: How can I find out if a child is enrolled in TRICARE, so I can see if I need to manually generate the CM01 and CM02?
A: When a TRICARE policy is added by the Employer Services Center (ESC) to a case with cash medical, ESC will send a high-priority message to the caseworker. In addition, CMOD report CY909R01 lists children currently enrolled in medical coverage.
Q: What if there are premiums being paid?
A: For active-duty service members, there is no cost for DEERS coverage. However, some reserve members of the armed services report that they do pay some premiums for TRICARE. We should still send out the CM01 and CM02, and if a party objects to termination of cash medical because cash medical is being used to pay TRICARE premiums, then we may opt to continue the cash medical while seeking a modification.
Q: If SoonerCare is no longer active, and the child is enrolled in TRICARE, do any cash medical payments issue to the CP?
A: Until the Notice of Termination of Cash Medical (CM07 or CM07A) has been filed, this is a possibility. This is why we need to make sure that we send out the CM01 and CM02 as soon as we receive verification of enrollment.

See OAC 340:25-5-168 ITS

Q: What if a parent has been ordered to provide TRICARE for a child but is unable to do so because the other parent will not provide required information or take necessary action? It has been reported that DEERS now requires a birth certificate for the child (not just a copy of the medical support order) and the Social Security Number (SSN) for the military sponsor. Uncooperative parents may not voluntarily exchange this information.
A: Cash medical can only be terminated upon proof of “enrollment” in coverage, not merely eligibility for enrollment. Title 43 OS § 118F states, cash medical would continue until enrollment is effective and either a new medical support order is entered or the cash medical is terminated per OAC 340:25-5-168(k). CSS may release an SSN to a party if it is needed in order to enroll a child in health coverage. See OAC 340:25-5-67(b) (2). CSS does not usually have certified copies of birth certificates for children. Check the language in your child support order for a requirement for parents to exchange information necessary to allow dependent health coverage to be accessed. Consider possible enforcement through a Motion for Production of Document or other means. If you are working a case in which a child may be newly eligible for TRICARE or other health coverage, consider setting a future hearing date to review the compliance of the parents with orders to exchange information necessary to secure insurance enrollment.

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