FALLS CHURCH, Va. –
The new year is upon us. Will 2022 be a year of big changes? If so, how will those changes affect you and your health care coverage? It isn’t uncommon for military families to experience lots of change. That’s why TRICARE allows you to enroll in, or change your TRICARE coverage after certain events, known as Qualifying Life Events
“You may not need to wait for TRICARE Open Season to make changes to your health plan,” said Shane Pham, program analyst with TRICARE Health Plan’s Policy and Programs Section at the Defense Health Agency. “Qualifying Life Events provide a unique opportunity for many TRICARE families to make enrollment changes to suit their new needs at a time other than the annual open season.”
What counts as a QLE?
A Qualifying Life Event is a certain change in your life that makes you eligible to enroll or change your TRICARE health plan outside of open season
. As outlined in the TRICARE Qualifying Life Events Fact Sheet
, TRICARE QLEs include military, family, and government-directed changes. Rules and restrictions apply to each QLE. Some common examples are:
How do QLEs work?
- Change in sponsor status that results in ineligibility to continue existing coverage. This includes retiring from active duty, separating from active duty, and more.
- Change in family composition. This includes getting married, getting divorced, having a baby, and more.
- Change of address. This includes moving away to college or relocating to a new country, city, region, or Zip+4 code.
- Losing sponsor or family member eligibility that results in ineligibility to continue existing coverage. This includes when a Retired Reserve member turns age 60 or when the sponsor or family member turns age 65 and becomes eligible for Medicare.
- Gaining or losing other health insurance. This includes employer-sponsored health insurance, Medicare entitlement, or Medicaid entitlement.
A QLE opens a 90-day period for you and your family to make enrollment changes. This means you have 90 days from the date of the QLE to enroll in a TRICARE health plan or change your existing plan. If you change your enrollment, your new coverage will start on the date of the QLE and run for as long as you remain eligible or disenroll. If you have a family, a QLE for one family member creates a chance for everyone who’s eligible to make enrollment changes during the 90-day QLE period. Your health plan options
after a QLE will depend on that event.
What actions do you take after a QLE?
After a QLE, you must take action to ensure you don’t experience a break in your TRICARE coverage. Following these steps will help:
1. Update the Defense Enrollment Eligibility Reporting System (DEERS)
. Anytime you or a family member experiences a QLE, you should update your DEERS record
. Keeping your information updated is essential for obtaining and maintaining TRICARE coverage. Depending on your QLE, you may need to enter a new address, add a spouse or child, or indicate other health insurance. Some of these actions may require you to go to an ID card office
and provide official documents, like a birth or marriage certificate.
2. Once your DEERS is updated, choose from three options based on your eligibility:
- Stay in the same TRICARE health plan. If you want to stay in the same TRICARE health plan, you don’t need to take further action after updating DEERS. Your coverage will continue as long as you remain eligible.
- Change TRICARE health plans. If you want to make a change to your TRICARE health plan or have to change your TRICARE health plan, make any eligible changes within 90 days of the date of the QLE. To explore health plan options, use the TRICARE Plan Finder.
- Enroll in a TRICARE health plan. If you’re eligible for TRICARE, but not enrolled in a TRICARE health plan within 90 days of the QLE, you’ll only be able to get medical care and pharmacy services at a military hospital or clinic if space is available. Learn about how to enroll in a TRICARE health plan. Once you enroll, your TRICARE contractor can confirm your enrollment.
There’s more to learn about QLEs and how they may change your TRICARE health plan options. For more information on how to navigate QLEs, go to Qualifying Life Events