TRICARE Prime Enrollment – Retirees and Their Family Members

Overview

TRICARE Prime is a managed care option similar to a civilian health maintenance organization (HMO). It is available in areas around military hospitals and clinics.

• Learn more about TRICARE Prime on TRICARE's Prime page.
• Learn more about using TRICARE Prime on our Getting Care - TRICARE Prime page.

Those eligible for TRICARE Prime include:

• retired service members
• family members and survivors of retired service members
• qualified former spouses

In addition, beneficiaries must be registered in the Defense Enrollment Eligibility Reporting System (DEERS) and must choose a  primary care manager (PCM) where TRICARE Prime is offered. Visit our PCM page to learn more.

You may enroll by:

• Beneficiary Web Enrollment (BWE)
  
• Mailing or faxing a TRICARE Prime Enrollment, Disenrollment and PCM Change Form.
  
• Telephone at 1-844-866-WEST (9378), Monday through Friday, 5:00 a.m.–9:00 p.m. (PT). 

Note: Be sure to include a three-month payment with your enrollment application.

Beneficiaries who remain eligible will be automatically re-enrolled each year unless they elect a different option or disenroll during the open enrollment season.

Changes in enrollment can only be made during TRICARE's Open Season or within 90 days of a qualifying life event (see below).  

Split Enrollment

Members of the same family may be enrolled in TRICARE Prime in different regions. Only one region will bill for the entire family enrollment. Individual and family enrollment fees for TRICARE Prime are separate from individual and family enrollment fees for TRICARE Select. The sponsor's enrollment determines which region receives the payment.

• The region where the sponsor is enrolled is the lead contractor and will bill for the entire family.
• If the sponsor is not enrolled, the region with the oldest enrolled family member is the lead contractor and will bill for the entire family.

Everyone on the account will be disenrolled for non-payment if payment is not received. 

Make sure to update your split enrollment information with each family member's regional contractor.

If you enroll in TRICARE Prime during TRICARE's Open Season, your enrollment is effective January 1 of the following year. Enrollment due to a qualifying life event (QLE), such as adding a newborn, is effective the date of the QLE.  

Fees

Retired service members and their family members have an annual enrollment fee for TRICARE Prime. The first quarterly payment is due with the enrollment application. 

A beneficiary’s group category is determined by the sponsor’s initial enlistment or appointment date:

• Group A: Sponsor’s enlistment or appointment date occurred prior to Jan. 1, 2018.
• Group B: Sponsor’s enlistment or appointment date occurred on or after Jan. 1, 2018.

Annual enrollment fees are:

Enrollment fees are subject to change each calendar year (Jan. 1–Dec. 31) except for Group A beneficiaries who are classified as a survivor of an active duty service member or for medically-retired members and their dependents. 

Failure to pay the total amount due will result in disenrollment from TRICARE Prime (see below). Visit our Make a Payment and Payment Options page for future payment information.

Qualifying Life Events (QLEs)

Visit our Qualifying Life Events page to learn how a change in your or a family member's life may affect your TRICARE enrollment options.

Voluntary disenrollment: You may voluntarily disenroll from TRICARE Prime. However, eligible beneficiaries not enrolled in a TRICARE plan are only covered for care at the military hospital or clinic under direct care if space is available. Beneficiaries can only re-enroll during the open enrollment season and/or in the event of a QLE.

You may disenroll by:

• Beneficiary Web Enrollment (BWE)
  
• Mailing or faxing a TRICARE Prime Enrollment, Disenrollment and PCM Change Form.
• Telephone at 1-844-866-WEST (9378), Monday through Friday, 5:00 a.m.–9:00 p.m. (PT).

If voluntarily disenrolling, you can request a specific disenrollment date. Otherwise, the disenrollment will be effective the day after your paid-through date.

Non-payment: If HNFS does not receive your premium payment within 30 days from the due date, you will be disenrolled for failure to pay. Your disenrollment will be effective the day following your policy paid-through date. Once disenrolled from TRICARE Prime, you will be only eligible for coverage at the military hospital/clinic under direct care if space is available. Claims for services after your disenrollment date will not be paid under your TRICARE Prime coverage. 
 

Reinstatement

If you are disenrolled from TRICARE Prime for failure to pay, you have 90 days* from your disenrollment date to be reinstated. A full payment is required to bring the policy current. 

• Visit our Make a Payment tool to determine your payment amount, bring your policy current and set up future automatic payments. 
• After 90 days, you must wait until the next TRICARE Open Season or for a qualifying life event to occur to re-enroll. 

*The 90-day rule does not apply to disenrollments due to catastrophic cap adjustments.