POSTNATAL AND NEWBORN CARE
Read on for essential information about what to expect in your baby's first weeks and what medical services are covered under TRICARE to ensure a healthy start for your baby. Your postnatal care appointments are included in the outpatient appointment Authorizations received during the prenatal period. If the Obstetrician recommends continued midwifery care during the postnatal period, a Referral (if not previously received) is required. Generally, homecare is not covered overseas, however in some locations, such as the Netherlands, community-based midwifery care is common practice or in Germany there is a cultural exception in place so that midwifery care can be covered under TRICARE.
NEWBORN ENROLLMENT INTO TRICARE
Your child will be covered under the same health care plan, as his/her sponsor, for their first 120 days, and claims for newborns process based on the sponsor parent's enrollment. Once your newborn has been registered in Defense Enrollment Eligibility Reporting System (DEERS), he/she will automatically be enrolled to TRICARE Select Overseas. The sponsor will then have 90 days from the auto-enrollment date to change the enrollment of the newborn to the desired/chosen plan. You can choose between TRICARE Prime Overseas, TRICARE Prime Remote Overseas (if eligible or command sponsored) or TRICARE Select Overseas. Please be aware that if you do not take enrollment action, your infant will remain enrolled in TRICARE Select Overseas.
Note: If the newborn is NOT REGISTERED IN DEERS after the 120th day from birth, they are only eligible for Direct Care through the Military Health System at a Military Treatment Facility (MTF) on a space available basis at which point all claims from overseas civilian providers will be denied.
For more information about registering your newborn for a TRICARE Health Plan please visit .
HOW DO I ENROLL MY NEWBORN IN DEERS AND TRICARE?
For the initial DEERS registration of your newborn child, you are required to physically present to a Uniformed Services ID Card Office - this also applies for overseas locations. Information can be found on .
TRICARE Overseas Health Care Plan enrollment changes, can be requested via telephone during or a (such as birth of a newborn). Please contact your TOP Regional Call Center and select Option 2 to contact the 24/7 TOP Beneficiary Support Center (BSC) and enroll telephonically (please ensure you have a copy of the sponsor's orders with you).
WHAT SERVICES AND SUPPLIES ARE COVERED FOR MY NEWBORN?
Since your newborn will be covered under the same TRICARE plan as the sponsor, from birth, all clinically necessary treatments and services, whether inpatient or outpatient, routine or urgent, will be covered. If you enroll your newborn in TRICARE Prime Overseas or TRICARE Prime Remote Overseas health plan, then coverage will be backdated to the date of birth. You will also be able to ask the TOP Claims Processor to reprocess any claims that were previously denied or processed under TRICARE Select but should be processed under the new enrollment.
| NEWBORN SCREENINGS | Your newborn baby will have blood drawn in the first days of life. Newborn screenings are a covered benefit; testing may vary depending on your geographical location. Additionally, your newborn should undergo a hearing test before leaving the hospital or shortly after. Read more about what to expect at: . |
| IMMUNIZATIONS | For recommended immunizations please visit the Centers for Disease Control and Prevention website at . Please note that immunization schedules vary from country to country. You should keep a record of when your child is immunized, the vaccine batch number and date of the vaccine expiration for each immunization your child is administered. If you have any concerns regarding your child's immunization regimen, please speak with your child's pediatrician/provider. |
| WELL-CHILD CHECKS | Well-child follow-up care is different in all overseas locations. Generally speaking, these services can be provided by a physician, such as your family doctor or pediatrician, for which the care is covered. However, government well-child programs can be free of charge, even when you are not a local citizen. Therefore, you should contact your TOP Regional Call Center or , so they can advise on the local requirements. Well-child checks include routine newborn care, health supervision examinations, routine immunizations, periodic health screening, and developmental assessment in accordance with the American Academy of Pediatrics (AAP) and Bright Futures guidelines. Well-child checks are covered for beneficiaries from birth to age 6 when services are provided by the attending pediatrician, family physician, ophthalmologist or optometrist, certified Nurse Practitioner (NP), or certified Physician Assistant (PA). Well-child services are considered preventive and are subject to the same cost-sharing/copayment and authorization requirements prescribed under the TRICARE Clinical Preventive Services benefit; more information can be found in the . |
| CIRCUMCISION |
Male circumcision performed during the newborn period (0-30 days) is a covered benefit under the TRICARE Male Circumcision Policy.
If a circumcision is performed after the newborn period, the service may be covered if it is medically necessary.
To be "medically necessary", it is appropriate, reasonable, and adequate for your condition.
Male circumcision performed outside the newborn period due to medical complications at birth or during the newborn period that prevented performing the circumcision within the newborn period, may be covered up to 30 days after discharge.
Please be aware that not all countries offer male circumcision routinely.
If you plan to have your baby boy circumcised, please ensure that you ask your Obstetric care provider if this can be arranged shortly following delivery.
If this is not possible, please contact your TOP Regional Call Center during pregnancy or immediately after delivery for provider options for this elective procedure to be considered.
When access to the circumcision procedure cannot be met in the enrolled location within the timefrime of 30 days, the approval period may be extended.
Conditions apply for this extension period; please contact either your Primary Care Manager (Prime) or TOP Regional Call Center for health care provider guidance.
In Near Patient Program (NPP) locations (Bahrain, Benelux (Belgium, Netherlands, Luxembourg), Germany, Greece, Italy, Japan, Poland, Romania, South Korea, Spain)
your can assist you in in arranging an appointment. Netherlands, Germany, and Italy Exceptions |
CHOOSING A PEDIATRICIAN FOR YOUR BABY
If you are a TRICARE Prime Overseas beneficiary, you will get pediatrician care from a military hospital or clinic if your Primary Care Manager (PCM) is located there. If you aren't located near a military hospital or clinic, or it can't offer you pediatrician care services, your PCM will give you a referral to a TRICARE-authorized civilian provider in your area. If you are a TRICARE Prime Remote Overseas beneficiary, you can call your TOP Regional Call Center and speak to a member of the TOP Authorizations Team or TOP Medical Team for pediatrician recommendations in your location. In locations, you can use the MyCare Overseas™ Beneficiary App to speak to a nurse who can provide recommendations. Additionally, you can also search for a provider overseas using the TOP Provider Healthcare Search Tool.
DOES TRICARE COVER BABY FORMULA?
TRICARE only covers baby formula that's medically necessary. Your child's doctor (pediatrician, PCM, or specialist, such as a pediatric registered dietitian) must diagnose and prescribe a special formula. This includes:
- Regular infant formula for children who have feeding tubes (separately, TRICARE also covers specialized formulas for adults or older children with feeding tubes or who can't eat solid foods).
- High-protein formula for infants on ketogenic diets to control seizures.
- Special formulas for those who can't digest certain foods or nutrients.
If you have a child whose medically necessary formula is unavailable, you should work with your pediatrician, PCM, or specialist accordingly. TRICARE will cover your appointments to talk about medically necessary formula options for your child. Please contact your TOP Regional Call Center for guidance on formula suppliers and coverage, alternatively more information can be found on or review of the TRICARE Policy on .