Is my wife covered under TRICARE for Life?

A: If a sponsor dies after they retired from active duty, their spouse stays eligible for TRICARE unless they remarry (unless the new spouse is a retired service member). When the surviving spouse has Medicare Part A and Part B, they'll have TFL.

Does TRICARE cover robotic surgery?

This policy includes any type of robotically-assisted surgery . Robotic-assisted surgery shall be cost-shared to the same extent as conventional surgery when the device being used has been approved by the U.S. Food and Drug Administration (FDA).

Does my wife get TRICARE for Life when she turns 65?

Your spouse younger than age 65 would remain eligible for TRICARE Prime or TRICARE Select until they turn age 65 and become eligible for Medicare Part A and Part B. TRICARE For Life is Medicare-wraparound coverage for retirees and their family members who are eligible for Medicare Part A and Part B.

Do military spouses get free TRICARE?

When you marry an active duty or retired service member, you become entitled to military benefits, including TRICARE . Your sponsor must register you in the Defense Enrollment Eligibility Reporting System (DEERS).

What will TRICARE not pay for?

In general, TRICARE excludes services and supplies that are not medically or psychologically necessary for the diagnosis or treatment of a covered illness (including mental disorder), injury, or for the diagnosis and treatment of pregnancy or well-child care.

Does TRICARE cover hysterectomies?

TRICARE Policy Manual, Chapter 4, Section 17.1 and Chapter 4, Section 5.3 authorizes coverage of hysterectomy when medically necessary and consistent with coverage criteria . Please note: Hysterectomy is not covered when performed solely for purposes of sterilization and/or hygiene in the absence of pathology.

Will TRICARE pay for liposuction?

Cosmetic surgeries purely for enhancing looks are not funded by TRICARE . These include face lifts, tummy tucks, and liposuction when there's no medical need. Such elective procedures come with out-of-pocket costs.

Can I get TRICARE for Life if my spouse is under 65?

TRICARE For Life (TFL) is Medicare-wraparound coverage if you are TRICARE-eligible and have Medicare Part A and B, regardless of age or place of residence . Coverage is only for those with Medicare and who are TRICARE-eligible. Coverage doesn't extend to family members.

How do I add my spouse to TRICARE for Life?

You need to register your spouse in the Defense Enrollment Eligibility Reporting System . You need to register in DEERS to get TRICARE. (DEERS) by visiting a uniformed services ID card-issuing facility and providing the required documentation. Visit the RAPIDS ID Card Office Online to find a facility near you.

Does military life insurance automatically go to the spouse?

How to access this benefit. Civilian spouses of service members signed up for full-time SGLI are covered under FSGLI automatically . The premium for the coverage is deducted automatically from the service member's pay. Military spouses married on or after Jan.

Who qualifies for TRICARE for Life?

TRICARE For Life (TFL) is available to TRICARE beneficiaries, regardless of age or where you live, if you have Medicare Part A and Medicare Part B . You're eligible for TFL on the first date you have both Medicare Part A and Medicare Part B.

TRICARE Manuals - Display Chap 4 Addendum A (Baseline, Dec 5, 2022) (2024)

Set #

Extract claim set control number.A unique reference to tie together a set of potential duplicateclaims.

Match Type

Claim set match criteria category:EXACT MATCH, NEAR MATCH, DATE OVERLAP, CPT-4, CODE, OTHER. Determinedduring the initial extract and set construction.

Claim Match

Claim match criteria category.Same as claim set categories.

M (match type code forline item)

Line item match criteria category.Same as claim set categories.

Risk

Financially underwritten, non-financiallyunderwritten indicator for claim. Please note that for the purposesof this system:

Financially underwritten =Risk

Non-Financially underwritten= Not at-risk.

Mass Change Level

The latest MASS CHANGE clusterrule applied to the claim.

Patient Region

Patient health service regioncode.

Provider Region

Provider health service regioncode.

Owner FI

Owner FI represents,for the claim set, the contractor that has been assigned responsibilityfor resolving particular potential duplicate claim sets. Typically,all claims within a set will have the same responsible FI/contractor(Resp FI), in which case the Owner FI willbe the same as the responsible FI/contractor. However, for “multi-contractor”claim sets where the responsible FI/contractors are not the samefor all claims within the set, an Owner FI is originallyassigned by the system to be the responsible FI/Contractor fromthe claim within the set having the latest PTC date.

Resp FI / Rsp FI

Resp FI or RspFI represents, for the claim, the contractor that is currently responsiblefor administering the claim. When the claim is initially extractedfrom TED, the Resp FI is identical to the ProcFI (Processing FI). However, contract awardingand transitions may require claim administration by a new contractor, inwhich case the system will assign a new Resp FI forthe claim.

Owner Region

Owner Region isa narrative descriptor of the contract number and represents, forthe claim set, the Owner FI/contractor region. Typically,all claims within a set will have the same Responsible Contract,in which case the Owner Region will be the same asthe Responsible Contract. However, for multi-contractorclaim sets where the contractors are not the same for all claimswithin the set, an Owner Region is assigned by thesystem to be the Responsible Contract from the claimwithin the set having the latest processed-to-completion date. The initialassignment is done in tandem with the assignment of OwnerFI.

Responsible Contract

Responsible Contract represents,for the claim, the contract under which the claim is currently administered.When the claim is initially extracted from TED, the ResponsibleContract is identical to the Processing Contract.However, contract awarding and transitions may require claim administrationunder a new contract, in which case the system will assign a new ResponsibleContract for the claim.

Dupe?

Dupe? is an indicatorto describe whether or not the claim or line item is a duplicate.During the extract processes Dupe? will be set to N (no)for the base claim within a set and will be set to blank for theremaining claims and line items.

Reason Code

Reason Code isa code used for each claim within a set to designate why the claimin the set is or is not a duplicate. During the initial loadingof a set into the system, the base claim within a set will be assigned(in conjunction with Dupe? being set to N)a reason code of BASE representing initial submission. The system willprovide an option list of valid codes intended to cover the majorityof possible conditions and a code for an “other” option for theoccasions when the condition cannot be classified. Some ReasonCode selections will require an additional explanation fieldfor further elaboration.

TED Adjust?

TED Adjust? isa flag for the user to designate which adjustment or cancellation correctsthe duplicate condition. All adjustments and cancellations thatapply are checked Y (yes), and those that do not applycan be left blank or checked N (no). The TEDAdjustment field is the sum (for the claim) of paid dollaramounts for those that apply. Display screens enable TED Adjust? tobe checked for any institutional claim and any non-institutionalline item.

Status

Status indicates the claimset life cycle phase from initial system loading to final purging. Status isset by the system as a consequence of specific user actions or periodicsystem functions.

Identified Recoup

Identified Recoup isa dollar amount that is entered by the user or by the system uponinitial determination that a claim or a line item is a duplicate.It represents the amount of overpayment for the claim or line itemthat has been identified for recoupment.

Actual Recoup

Actual Recoup isa dollar amount that is entered by the user upon completion of recoupmentfor a duplicate claim. It represents the amount of overpayment for theclaim that has actually been recouped.

TED Adjustment

TED Adjustment isa dollar amount that is maintained by the system (not by the user)to accumulate TED adjustment or cancellations made during resolutionof a duplicate claim. It is calculated as the sum of all adjustmentand cancellation paid amounts that have been flagged by the useras being associated with correcting the duplicate. This is the sumof claim level paid amounts for institutional claims and line itempaid amounts for non-institutional claims.

ID Recoup

ID Recoup is adollar amount calculated by the system as the sum of Identified Recoup amountsfor all claims within a set. It represents the total amount of overpaymentfor the claim set that has been identified for recoupment.

Actual Recoup

Actual Recoup isa dollar amount calculated by the system as the sum of claim levelactual recoupment amounts for all claims within a set. It representsthe total amount of overpayment for the set that has actually beenrecouped.

Adjust Amount

Adjustment Amount isa dollar amount calculated by the system as the sum of TEDAdjustment amounts for all claims within a set. It representsthe total amount of adjustments and cancellations that have beenflagged by the user as being associated with correcting all duplicateclaims within the set.

Initial Load Date

Initial Load Date representsthe date the claim set was initially loaded into the system. TheLASTDATE reflects the most recent claim set update date - for specific typesof updates.

Current Load Date

Current Load Date representsthe date the claim set was initially loaded into the system or thedate set ownership changed, or the date a new claim was appendedto the set, whichever is the latest date.

Last Update Date

Last Update Date representsthe most recent date a claim set was updated. Changes to the following will changethe Last Update Date: Status, Match Type, Multi-FIIndicator, Owner FI, Owner Region, ID Recoup, Actual Recoup, Set AdjustmentAmount, and Adjust Indicator. The Last Update Date will not change solelydue to a change to: User Defined Codes, Dupe? field, Solicited (S?) Indicator,TED Adjust?, Reason Code, Reason Code Explanation, or Notepad.

S? is the SolicitedIndicator.

Set User Def

TRICARE Manuals - Display Chap 4 Addendum A (Baseline, Dec 5, 2022) (2024)

FAQs

Is my wife covered under TRICARE for Life? ›

Who qualifies for TRICARE for Life? ›