Newborn Eligibility and Enrollment Coverage
Newborn children of TRICARE Prime beneficiaries are automatically covered as TRICARE Prime beneficiaries for 60 days after birth or adoption as long as one other family member is enrolled in TRICARE Prime.
Parents have 60 days from date of birth or adoption of TRICARE-eligible children to enroll them in TRICARE Prime to avoid delays or gaps in processing health care authorizations or claims. This also prevents higher out-of-pocket expenses for new parents. On the 61st day, the child is automatically covered by TRICARE Standard.
Here are some key points to know about newborn coverage:
- As long as one parent is enrolled into Prime, the newborn is eligible for Prime enrollment.
- Claims for newborns automatically process as Prime for 60 days.
- Starting on the 61st day following delivery, the newborn will be covered under TRICARE Standard if not enrolled into Prime.
If no family member is enrolled in TRICARE Prime at the time of the child’s birth or adoption, he or she is automatically covered by TRICARE Standard and TRICARE Extra.
Additionally, if a daughter who is an active duty family member (ADFM) has a baby, the baby is not considered a TRICARE beneficiary unless the baby is adopted by a TRICARE sponsor or they are covered by their biological sponsor, who is an active duty Service member (ADSM).
To assist your TRICARE patients, you can refer them to this TRICARE maternity fact sheet.