Tricare Covered My Baby Delivery During HPSP!

After receiving the HPSP stipend for two years, my husband (Sponsor) and I (Dependent) planned to add an addition to our family. I learned that even though HPSP students are Reservists, they can only use Tricare benefits during the 45 active duty days each year. It is called "School Orders" -- 45 days once any time per year, or a one-time officer training course anytime during HPSP program would satisfy the active duty yearly requirement - "school orders" doesn't mean much BTW, you just stay in school like normal you are just not allowed to leave the area/city.

There are two things to make sure before anything:

1. the mom-to-be has health insurance coverage

2. mom-to-be's doctor's office and delivery hospital take Tricare as secondary insurance. I suggest to enroll in Tricare Select - if you are the dependent, that way, you may keep seeing your civilian OB.

Here is how we were able to use Tri-Care to cover our daughter's delivery:

1. The first step is to make sure you (dependent) are registered in DEERS. You (dependent) are PROBABLY already in DEERS from the Sponsors HPSP application process, but make sure. You won't be able to "pre-register" your baby in DEERS; you have to wait until after delivery. You (dependent) also need to get a Military ID card at an ID Card office. It may take months before you can get an appointment, but some locations offer walk-in services. If you cannot go with your sponsor, please call ahead to find out what additional documents you need to bring. To make an appointment and check the service of the ID Card Office locations near you, click here https://idco.dmdc.osd.mil/idco/ and go to RAPIDS. For more information about the CAC card, please refer to My Army HPSP Experience - CAC.

2. The key to use the maternity benefits is to "count the date right." Here is my example:

My due date was May 27, 2018. My husband submitted the application for Active Duty ("School Orders") before April 15, 2018 and then Active Duty/Tricare coverage started on May 1st. Your requested start date on the application has to be something like "3 weeks out" so they have time to process it. After that, he called Tricare to select the health care plan for me and himself. I had a C-section 10 days later (2 weeks earlier than my scheduled due date) - so don't pick a date that is too close to your due date.

Tips: As soon as the Sponsor's School Orders/Active Duty 45 days starts, then call Tri-Care and activate your coverage. This is why you want to have DEERS & ID cards squared away. Because you can't call Tri-Care to start coverage until the Active Duty starts, YOU NEED TO BE READY.

3. After getting the insurance set up, please inform your doctor's office and your delivery hospital that you have Tricare as a secondary insurance. Tricare cannot be your primary insurance as an HPSP recipient/dependent. I had amazing doctors, hospital services, and anesthesiologists. However, the billing part is more complicated with two insurance companies involved. Some of my providers are still having an insurance claim war with my primary insurance and Tricare until today (I will explain later), but the good thing is that I know the big bills are covered. Here are my numbers:

My primary insurance back in 2018 had a deductible of $600, out of pocket max was $1800 for individual (I was the only enrollee); the minute my daughter was born, the insurance changed from an individual plan to a family plan, which increased my deductible to $1200, out of pocket maximum to $3400. I checked with my primary insurance before delivery, and was told no matter C-section or Vaginal Birth I got, a three-day hospital stay for the delivery was going to cost $3400. I ended up paying a couple hundred dollars out of pocket with Tricare Select as secondary insurance.

Tips: when pre-registering at your hospital, PUT TRICARE ON THE PAPERWORK EVEN IF IT DOES NOT START UNTIL A FEW DAYS LATER, confirm again on your delivery date (I assume your Tricare is effective on that day). Our hospital for some reason billed my husband's primary insurance without using Tricare. They were supposed to bill my primary insurance (through work), AND use Tricare as a secondary insurance.

In 2019, my daughter had a dacryocystorhinostomy (DCR) procedure done (she had a nasolacrimal duct obstruction and the DCR is a simple probing procedure to open it). We used Tricare benefits again (using the same timing of school orders vs surgery just like the delivery), and it was all covered. Another $1000 saved here. It was definitely not that difficult to save money. Feel free to ask me any questions, but I do suggest to read the Tricare benefits carefully and get more information from your doctor's office and delivery hospital before you make the decision!