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Ensuring retiree medical care

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As his retirement date on the first of the month drew closer, Chief Petty Officer Matt Jefferson counted the days. He’s glad his wife Judy did, too. 

She circled the 20th of the current month on the calendar with a reminder to enroll the family for TRICARE Prime health care coverage as retirees on or before that date. 

“If I hadn’t remembered to renew our coverage, we would have been without Prime coverage when I hurt my leg falling off the kitchen stool,” Judy said. “Although we still could have used TRICARE Standard or Extra, we would have had to pay more out of pocket.” 

Individuals who’ve been in the TRICARE system for any length of time may have heard of the “20th of the month rule” without really understanding what it means. 

TRICARE’s “20th of the month rule” is designed to prevent a service member’s TRICARE Prime health care coverage from being interrupted, whether the military member is enrolling for the first time or reenrolling in anticipation of retirement. 

TRICARE Prime coverage requires service members to complete and submit a TRICARE Prime Enrollment Application (available on www.TriWest.com) and the appropriate enrollment fee. Under most circumstances, the service member must submit the form and the fee on or before the 20th of the current month, so that Prime coverage will be effective on the first day of the following month. 

For new enrollments, if TriWest Healthcare Alliance, the TRICARE West Region contractor, receives a new Prime enrollment application on or before the 20th day of the month, the service member and family will be enrolled in Prime effective the first day of the following month. But if the enrollment form and fee are received after the 20th of the month, Prime enrollment will not be effective until the first day of the second month after application is received. 

For example, if the application and fee are received by TriWest on or before Feb. 20, the service member’s Prime enrollment will have an effective date of March 1. If the application is received on Feb. 21 or later, that enrollment will not begin until April 1. 

If an active duty service member’s date of retirement falls on the first of the month (as it does for most), and he or she chooses to reenroll in Prime and returns the completed enrollment form and fee to TriWest on or before the 20th of the month preceding the retirement date, Prime coverage will begin on the first. This will help ensure continuous, no-lapse coverage for the retiree and his family. 

If the retirement date does not fall on the first of the month, the Prime enrollment application and fee must be submitted within 30 days before the beneficiary’s retirement date. That way the effective enrollment date will be the retirement date, and there will be no break in coverage. 
(Source: TriWest Healthcare Alliance)