Qualifying life events (QLEs) are situations that allow you to change your Tricare health plan without waiting for the annual open season. QLEs can be a powerful tool to get the right plan without delay. Therefore, it’s worth knowing what counts as a QLE and how the process works.
Tricare, like most health care programs, won’t let you switch between plans whenever you feel like it. Generally speaking, you have to wait until the annual open season to be able to switch your health care coverage. Tricare’s open season typically runs from the Monday of the second full week in November to the Monday of the second full week in December. Changes made during this open season take effect Jan. 1.
What Counts as a QLE
However, you can also make changes to your Tricare plan within 90 days of someone in your family having a qualifying life event. Tricare has a pretty long list of QLEs. These include:
- Retiring
- Separating from the military
- Activating or deactivating from reserve or National Guard
- Marriage, divorce or annulment
- Birth or adoption of a child
- Placement of a child by a court in a member’s home
- Children becoming adults
- Death in the family
- Child moving away to college
- Relocation to a new country, city, region or ZIP code
- Government-directed primary care manager change
- Government-directed health plan change
- Gaining or losing permission to have family members accompany the military member at an overseas assignment
- A retired reservist turning age 60 and gaining Tricare eligibility
- Becoming eligible for Medicare
- Change in eligibility status for either member of a joint service family
- Losing or gaining other health insurance, such as employer insurance
Rapid Response to Changing Circumstances
As you can see, many people experience one or more of these situations each year, opening opportunities to change Tricare plans.
For example, let’s say you’re on Tricare Prime. Prime requires all care to be coordinated through the patient’s primary care manager. You need a referral for any specialty care, and speciality care must be from a Prime network provider.
Your child injures their knee playing soccer, and you’re frustrated with the process to get the necessary radiological imaging and referrals to physical therapy. But, your other child just moved to college. As long as you’re within 90 days of that change of address, you’re in a QLE period that would allow you to switch to Tricare Select. With Select, you don’t need a referral and you can go to any Tricare-authorized provider, not just those who accept Tricare Prime.
Switching Tricare Coverage After a QLE
In order for the QLE to unlock your ability to change Tricare plans, you’ll first need to make any relevant changes to your personal information in the Defense Enrollment Eligibility Reporting System (DEERS), such as updating an address. Then contact Tricare within 90 days of the QLE to make your plan change. You should be able to do this online or by telephone.
The plan change will be retroactive to the date of the QLE, so it’ll make your life easier if you make the change as close to the QLE as possible. Otherwise, you may need to refile claims for care that took place during that period of time. That can get messy, so it’s best to avoid it.
If your change incurs the payment of any enrollment fees or premiums, you’ll need to pay those retroactively to the date of the QLE. For example, if you’re part of a retiree family whose sponsor entered the military before Jan. 1, 2018, and you switch from Tricare Select to Tricare Prime, you’ll owe those additional enrollment fees from the date of the QLE to the date that you made the switch.
It’s important to note that Uniformed Services Family Health Plans (USFHP) are a Tricare Prime primary care manager (PCM) choice and that movement between USFHP and military-managed Tricare Prime does not have to wait for an open season or QLE. You can switch between military-managed Tricare Prime and a USFHP at any point in time.
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