TRICARE Young Adult (TYA) Program

Military.com

(Updated: 4/27/2011)

Applications are now available for TRICARE Young Adult, the new premium-based health care plan for adult dependent children up to age 26. TYA provides access to medical and pharmacy benefits. The plan does not include dental coverage.

TRICARE Young Adult coverage can be purchased after eligibility for "regular" TRICARE coverage ends at age 21 (or 23 if enrolled in a full course of study at an approved institution of higher learning). Currently, TRICARE Standard coverage is available worldwide, but TRICARE Prime coverage will be available at a later date.

TYA participants may visit any TRICARE-authorized provider, network or non-network. Care at military treatment facilities is on a space-available basis only. They do not need a referral for any type of care but some services may require prior authorization. The type of provider determines how much the amount of out-of-pocket expenses. Visiting a network provider will result in less out of pocket, in addition to the convenience of having the network provider file the claims directly.

TRICARE Young Adult Eligibility Requirements

To be eligible for TRICARE Young Adult an adult dependent must be:

A dependent of an eligible uniformed service sponsor
- If the sponsor is a non-activated member of the Selected Reserve of the Ready Reserve or of the Retired Reserve, the sponsor must be enrolled in TRICARE Reserve Select or TRICARE Retired Reserve for the dependent to be eligible to purchase TRICARE Young Adult coverage.
Unmarried
At least age 21 but not yet 26 years old (Note: those enrolled in a full course of study at an approved institution of higher learning and their sponsor provided 50 percent of their financial support, their eligibility may not begin until age 23)
Not eligible to enroll in an employer-sponsored health plan based on his or her own employment
Not otherwise eligible for other TRICARE program coverage.

TRICARE Young Adult Monthly Premiums & Out-of-Pocket Costs

TYA is a pay-to-play program requiring eligible dependents to pay a monthly premium. TRICARE Young Adult premium rates are established annually on a calendar year basis. The 2011 monthly premium is $186.00 per month

After meeting an annual deductible, the insured is responsible to pay a cost-share (or percentage). Here's a quick snapshot of TRICARE Young Adult costs:

Type of Provider	Outpatient Cost Share	Inpatient Cost Share
Network Providers	Active duty family member: 15% of the negotiated fee All others: 20% of the negotiated fee	Active duty family member: $16.85 per day ($25 minimum charge) All others: $250 per day or 25% for institutional services (whichever is less) plus 25% for separately billed professional services
Non-Network Providers	Active duty family member: 20% of the allowable charges All others: 25% of the allowable charges	Active duty family member: $16.85 per day ($25 minimum charge) All others: $535 per day or 25% for institutional services (whichever is less) plus 25% for separately billed professional services
Overseas Providers	Active duty family member: 20% of the billed charges All others: 25% of the billed charges	Active duty family member: Per diem rate ($25 minimum charge) All others: 25% for institutional services plus 25% for separately billed professional services

Note: The TRICARE Prime option, once it?s available to purchase through TRICARE Young Adult, will have different set of out-of-pocket costs.

Who Should Consider TYA Coverage?

TYA is a great option for unmarried, adult children who have "aged out" of regular TRICARE coverage and who are transitioning to live independent of their parents. The plan provides comprehensive medical and pharmacy benefits. And, because the insured can see any provider, he or she doesn't have to change providers if they already have one. For more information, download a copy of the TRICARE Young Adult Flyer.

Getting TYA Coverage Started

TRICARE Young Adult coverage may be purchased at any time. Download the TRICARE Young Adult Application for the appropriate region and mail or fax the completed form and initial three-month premium-payment to the regional contractor (addresses and fax numbers listed below).

Download the North Region TRICARE Young Adult Application.
Health Net Federal Services, LLC
P.O. Box 870162
Surfside Beach, SC 29587-9762
Fax: 1-888-745-1545

Download the South Region TRICARE Young Adult Application.
TRICARE Young Adult Program
P.O. Box 538025
Atlanta GA 30353-8025
Fax: 1-877-371-6661

Download the West Region TRICARE Young Adult Application.
TriWest Healthcare Alliance
P.O. Box 43315
Phoenix, AZ 85080-3315
Fax: 1-866-259-0419

Download the Overseas TRICARE Young Adult Application.
International SOS Assistance, Inc.
TRICARE Young Adult (TYA) Enrollments
P.O. Box 11520
Philadelphia, PA 19116
Fax: 1-215-354-5015

After the appropriate regional contractor processes the application, the applicant will receive a welcome letter along with an enrollment card. When the application is processed, TRICARE Standard coverage will begin the first day of the following month. However, a one-month waiver will allow coverage back to May 1, 2011. That can only occur as long as enrollment forms and payment are received (not postmarked) by the regional contractor before May 31, 2011.

The TRICARE Young Adult start date will be printed on the enrollment card. Additionally, the insured dependents will receive a copy of the TRICARE Standard Handbook.

TRICARE wants to remind members to please keep a copy of their application until they receive the enrollment card. If the beneficiary must seek care before receiving the enrollment card, they should contact their regional contractor to verify their TRICARE Young Adult start date.

Purchasing Retroactive TRICARE Young Adult Coverage

TYA coverage (TRICARE Standard benefit only) can be purchased retroactively back to January 1, 2011, or back to the date when the beneficiary became eligible for coverage. All premiums must be paid back to that date in order to be reimbursed. Beneficiaries who may want to purchase retroactive coverage should keep receipts for care received to get reimbursed for covered services. The opportunity to purchase retroactive coverage ends on September 30, 2011.

Check out the TRICARE Young Adult FAQ's to learn more.